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August 1989–June 1990

Opposition to the government's NHS reforms

Despite growing opposition to the government's NHS reform programme and Thatcher's resulting concerns, Kenneth Clarke, Secretary of State, refused to back down.

29 June 1990

National Health Service and Community Care Act 1990

Legislation provided for the 'purchaser/provider split'. This marked the start of an internal market in the NHS and changes to local authorities' social care functions.

19 October 1990

Health Select Committee

The Health Select Committee and the Social Security Select Committee were established, replacing the Social Services Select Committee.

1 April 1991

The first NHS trusts

These trusts assumed responsibility for the ownership and management of hospitals, previously managed or provided by regional, district or special health authorities.

July 1991

The Citizen's Charter

The government launched the Citizen's Charter to redefine the relationship between citizens and public service, seeking to set out the rights and entitlements of patients.

November 1992

Private Finance Initiative (PFI) schemes

In 1992, the Conservative government introduced private finance initiatives (PFI). The main objective was to harness the private sector's efficiency, management and commercial expertise.

October 1994

Total purchasing pilot scheme

A total purchasing pilot (TPP) scheme was launched, allowing GPs in a locality to purchase all hospital and community health services for their patients.

January 1995

Health committee report: 'Priority setting in the NHS: purchasing'

The Health Committee published a report on purchasing, endorsing a separation between strategy and operational delivery as an approach to priority setting.

28 June 1995

Health Authorities Act 1995

The Act replaced regional health authorities, district health authorities and family health services authorities with regional NHS executive offices.