We now need to sacrifice the last “sacred cow”

When I read this article “Thatcher’s NHS plans caused cabinet ‘riot’” in the Times 25th Nov 2016 (Henry Zeffman) I was interested to read that, 34 years ago, in 1982, Mrs thatcher had predicted what would become accepted as necessary. All suggestions have been wholly or partially accepted EXCEPT for the reported recommendation on the then NHS. We need a new NHS where the power of the large mutual dictates the price, choice, and standard of care. Devolution is bad for smaller mutual such as Wales.. But there is no need to abandon the Health Service as a National Institution IF we agree to ration overtly, and discuss sensibly and pragmatically the many unpalatable options.Image result for sacred cow health cartoon

Margaret Thatcher secretly fought to keep alive radical plans to dismantle the welfare state even after they caused a cabinet “riot”, according to newly released government files.

The proposals drawn up by the Central Policy Review Staff (CPRS), a government think tank, went further than any reforms Thatcher undertook during her decade in Downing Street.

They included replacing the NHS with an insurance-based service, ending the state funding of higher education, ending the link between benefit rises and inflation, charges for schooling and cuts in defence spending.

When Geoffrey Howe, the chancellor, introduced the proposals at a special cabinet meeting on September 9, 1982 it was met with fierce resistance by the moderates, or “wets”, in Mrs Thatcher’s ministerial team.

Lord Lawson of Blaby, the energy secretary who replaced Howe as chancellor the following year, recalled in his memoirs that it was “the nearest thing to a cabinet riot in the history of the Thatcher administration”.

Details of the report were leaked to The Economist, causing a public outcry.

Thatcher responded by declaring from the Conservative Party conference platform in Brighton the next month that the NHS was “safe with us”. She later claimed to have been “horrified” by the CPRS plan.

However, Treasury papers from the period released by the National Archives show that the prime minister and her chancellor continued to struggle to keep the proposals alive.

On November 26, 1982, nearly three months after the cabinet meeting, a Treasury official named P Mountfield told Howe that the prime minister had convened meetings with the key ministers whose departments were concerned by the proposals: Keith Joseph, education secretary; John Nott, defence secretary, and Norman Fowler, health secretary.

“This series of meetings is designed to soften up the three big spenders. Without their support the operation will not work,” Mr Mountfield wrote.

“Your main aim, I suggest, should be to ensure that no sacred cows are prematurely identified. Given the prime minister’s concern about the NHS, this may be difficult.”

Another Treasury official warned Howe that the opposition of the cabinet would scupper implementing the CPRS’s ideas.

GW Monger wrote: “DHSS [department of health and social security] officials say there is no chance Mr Fowler would agree to further study of this idea. I imagine that in the circumstances, and especially given the prime minister’s speech at Brighton, it is difficult to press them.”

Though Howe maintained that deep reform was needed to cut public spending, he was alarmed when the Adam Smith Institute wanted to publish the “Omega Project”, its own vision for privatisation and deregulation.

Howe wrote: “Every proposal will be seized on and hung round our neck. I see v great harm.”


One of Geoffrey Howe’s most complex tasks as chancellor was working out what to do with the Treasury wives.

In January 1982 the chancellor summoned his ministers and senior officials for a weekend discussing Britain’s economic difficulties and instructed his permanent secretary to make arrangements for the wives of those in attendance.

“The chancellor is anxious that any participant of the seminar who wishes to be accompanied by his wife should be able to do so,” wrote Sir Douglas Wass.

“The wives would join participants at meals but would otherwise ‘amuse themselves’.”

Sir Douglas issued a dress code for dinner — lounge suits for men and “short dresses for ladies”.

After the Tories’ 1979 election victory the first call Howe received was from his defeated Labour predecessor. Denis Healey passed on a message from his wife, Edna, to Howe’s wife Elspeth, warning her not to move into the flat above 11 Downing Street until the “antediluvian” kitchen was refurbished.

Thatcher was reluctant to approve this. In December 1979 a Treasury official wrote to No 10 complaining that three months after they had submitted plans, costing £4,150, there had been no response, despite three phone calls.

Sally Gainsbury released this in the FT 2012: NHS privatisation leak damages Thatcher and in retrospect this rejection must have led to FundHolding.

The full text of an internal paper that was at the heart of one of the most damaging leaks in Margaret Thatcher’s first term is laid bare in files from 1982 – the cabinet office’s Central Policy Review Staff’s review of “Longer-Term Options”.

Most controversially, these options included dismantling of the National Health Service, which would be replaced by a system of compulsory private insurance, with state funded healthcare only for the poorest or most frail.

The extension of private school education was also proposed, to be encouraged with vouchers and tax breaks, and funded by an introduction of charges for state schools.

The paper was widely leaked at the time and caused outcry, prompting Margaret Thatcher to pledge “The National Health Service is safe in our hands”.

Although ministers attempted to distance themselves from the paper at the time, the official record of the cabinet meeting at which it was discussed – alongside “disturbing” Treasury projections on public spending – shows the cabinet concluded that “much could be done to reduce the size of the public sector by privatisation in areas such as healthcare, education and many local authority functions”.

cropped-nhs-hands-safenh01.jpgIts a health financial emergency – and the Chancellor has taken no direct action.

We must think the unpalatable to stop death of NHS, say doctors



This entry was posted in A Personal View, Political Representatives and activists, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s