Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability , the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.
115-611: The National Health Service ( NHS ) is the publicly funded healthcare system in England , and one of the four National Health Service systems in the United Kingdom . It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde . Primarily funded by the government from general taxation (plus a small amount from National Insurance contributions), and overseen by
230-452: A 1979 Marxism Today article. However, this is not true as Tony Heath first used the term in an article he wrote that appeared in Tribune on 10 August 1973. Writing as Tribune ' s education correspondent, Heath wrote: "It will be argued that teachers are members of a profession which must not be influenced by political considerations. With the blight of Thatcherism spreading across
345-612: A characteristic of Thatcherism, Thatcher was far from consistent on the issue, only becoming truly Eurosceptic in the last years of her time as prime minister. Thatcher supported Britain's entry into the European Economic Community in 1973, campaigned for a "Yes" vote in the 1975 referendum and signed the Single European Act in 1986. Towards the end of the 1980s, Thatcher (and so Thatcherism) became increasingly vocal in its opposition to allowing
460-407: A concept. Society is made up of people. It is people who have duties and beliefs and resolve. It is people who get things done. [Thatcher] prefers to think in terms of the acts of individuals and families as the real sinews of society rather than of society as an abstract concept. Her approach to society reflects her fundamental belief in personal responsibility and choice. To leave things to society
575-480: A conservative social system based on traditional morality. There would still be a minimal safety net for the poor, but the major emphasis was on encouraging individual effort and thrift . Thatcherism sought to minimise the importance of welfare for the middle classes and reinvigorate Victorian bourgeois virtues. Thatcherism was family centred, unlike the extreme individualism of most neoliberal models. It had its roots in historical experiences such as Methodism and
690-507: A cost-efficient and cost-effective manner (microeconomic efficiency). A range of measures, such as better payment methods, have improved the microeconomic incentives facing providers. However, introducing improved incentives through a more competitive environment among providers and insurers has proved difficult. A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in
805-599: A dash of populism . Thatcherism attempts to promote low inflation, the small state and free markets through tight control of the money supply , privatisation and constraints on the labour movement . It is often compared with Reaganomics in the United States, economic rationalism in Australia and Rogernomics in New Zealand and as a key part of the worldwide economic liberal movement. Thatcherism
920-800: A deficit on their budgets at the end of the financial year. Failure to meet financial objectives could result in the dismissal and replacement of a trust's board of directors, although such dismissals are enormously expensive for the NHS. In April 2013 a new system was established as a result of the Health and Social Care Act 2012 . The NHS budget is largely in the hands of a new body, NHS England. NHS England commissions specialist services and primary care. Acute services and community care are commissioned by local clinical commissioning groups (CCGs) led by GPs. From April 2021 all CCGs have become part of Integrated Care Systems. The vast majority of NHS services are free at
1035-556: A fee more amenities are provided. Patients using these beds are in an NHS hospital for surgical treatment, and operations are generally carried out in the same operating theatres as NHS work and by the same personnel but the hospital and the physician receive funding from an insurance company or the patient. These amenity beds do not exist in all publicly funded systems, such as in Spain. The NHS also pays for private hospitals to take on surgical cases under contract. Many countries are seeking
1150-455: A financial disincentive due to potential legal costs) for individual hospitals to do so. The Road Traffic (NHS Charges) Act 1999 introduced a standard national scheme for recovery of costs using a tariff based on a single charge for out-patient treatment or a daily charge for in-patient treatment; these charges again ultimately fell upon insurers. This scheme did not however fully cover the costs of treatment in serious cases. Since January 2007,
1265-576: A government 'promise' made in 2020 to give NHS workers a 2.1% pay rise, which was voted for in a long-term spending plan in January 2020 but the Department of Health considered to be not legally binding. Prime Minister Boris Johnson defended the 1% pay rise, stating that the government was giving workers "as much as we can" in light of the COVID-19 pandemic and that he was "massively grateful" to
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#17328016261641380-622: A government majority of 88 and following more than 1,000 amendments in the House of Commons and the House of Lords. The total budget of the Department of Health in England in 2017/18 was £124.7 billion. £13.8 billion was spent on medicines. The National Audit Office reports annually on the summarised consolidated accounts of the NHS. The population of England is aging, which has led to an increase in health demand and funding. From 2011 to 2018,
1495-574: A government social security system (as in Australia , France , Belgium , Japan and Germany ) with a separate budget and hypothecated taxes or contributions. The proportion of the cost of care covered also differs: in Canada, all hospital care is paid for by the government, while in Japan, patients must pay 10 to 30% of the cost of a hospital stay. Services provided by public systems vary. For example,
1610-468: A national level, including: In the year ending in March 2017, there were 1.187 million staff in England's NHS, 1.9% more than in March 2016. There were 34,260 unfilled nursing and midwifery posts in England by September 2017, this was the highest level since records began. 23% of women giving birth were left alone part of the time causing anxiety to the women and possible danger to them and their babies. This
1725-468: A nineteenth-century Liberal". As Ellen Meiksins Wood has argued, Thatcherite capitalism was compatible with traditional British political institutions. As prime minister, Thatcher did not challenge ancient institutions such as the monarchy or the House of Lords , but some of the most recent additions, such as the trade unions. Indeed, many leading Thatcherites, including Thatcher herself, went on to join
1840-518: A not-for-profit trust that pays out for healthcare according to common rules established by the members or by some other democratic form. In some countries, the fund is controlled directly by the government or by an agency of the government for the benefit of the entire population. That distinguishes it from other forms of private medical insurance , the rights of access to which are subject to contractual obligations between an insured person (or their sponsor) and an insurance company , which seeks to make
1955-471: A particular set of principles and also by some of her friends who had little sympathy for what he called "the English political tradition" because it facilitated "compromise and consensus". Utley argued that a free and competitive economy, rather than being an innovation of Thatcherism, was one "more or less permanent ingredient in modern Conservative philosophy": It was on that principle that Churchill fought
2070-578: A political platform emphasising free markets with restrained government spending and tax cuts that gets coupled with British nationalism both at home and abroad. Thatcher herself rarely used the word "Thatcherism". However, she gave a speech in Solihull during her campaign for the 1987 general election and included in a discussion of the economic successes the remark: "that's what I call Thatcherism". The Daily Telegraph stated in April 2008 that
2185-432: A profit by managing the flow of funds between funders and providers of health care services. When taxation is the primary means of financing health care and sometimes with compulsory insurance, all eligible people receive the same level of cover regardless of their financial circumstances or risk factors. Most developed countries have partially or fully publicly funded health systems. Most western industrial countries have
2300-566: A publicly funded healthcare system also has a parallel private system for patients who hold private medical insurance or themselves pay for treatment. In those states, those able to pay have access to treatment and comforts that may not be available to those dependent upon the state system. From the inception of the NHS model (1948), public hospitals in the United Kingdom have included "amenity beds" which would typically be siderooms fitted more comfortably, and private wards in some hospitals where for
2415-503: A single-charge pre-payment certificate that allows unlimited prescriptions during its period of validity. The high and rising costs of some medicines, especially some types of cancer treatment, means that prescriptions can present a heavy burden to the primary care trusts , whose limited budgets include responsibility for the difference between medicine costs and the low, fixed prescription charge. This has led to disputes whether some expensive drugs (e.g., Herceptin ) should be prescribed by
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#17328016261642530-457: A sound start in life—yes, cheated. The law was opposed by many gay rights advocates such as Stonewall and OutRage! . Tony Blair's Labour government repealed it in 2000 (in Scotland) and 2003. Conservative prime minister David Cameron later issued an official apology for previous Conservative policies on homosexuality, specifically the introduction of the controversial Section 28 laws from
2645-538: A system of social insurance based on the principle of social solidarity that covers eligible people from bearing the direct burden of most health care expenditure, funded by taxation during their working life. Among countries with significant public funding of healthcare there are many different approaches to the funding and provision of medical services. Systems may be funded from general government revenues (as in Canada , United Kingdom , Brazil and India ) or through
2760-476: A systematic, decisive rejection and reversal of the post-war consensus inside Great Britain in terms of governance, whereby the major political parties largely agreed on the central themes of Keynesianism , the welfare state , nationalised industry , and close regulation of the British economy before Thatcher's rise to prominence. Under her administration, there was one major exception to Thatcherite changes:
2875-401: A table while saying "this is what we believe". In contrast to previous government policy, monetarism placed a priority on controlling inflation over controlling unemployment. According to monetarist theory, inflation is the result of there being too much money in the economy. It was claimed that the government should seek to control the money supply to control inflation. By 1979, it was not only
2990-563: A unique role in the training of new doctors in England, with approximately 8,000 places for student doctors each year, all of which are attached to an NHS University Hospital trust. After completing medical school, these new doctors must go on to complete a two-year foundation training program to become fully registered with the General Medical Council . Most go on to complete their foundation training years in an NHS hospital although some may opt for alternative employers such as
3105-614: Is all too similar to Reaganism : free-market rhetoric masking statist content". Stuart McAnulla said that Thatcherism is actually liberal conservatism , a combination of liberal economics and a strong state. Another important aspect of Thatcherism is the style of governance. Britain in the 1970s was often referred to as "ungovernable". Thatcher attempted to redress this by centralising a great deal of power to herself as prime minister, often bypassing traditional cabinet structures (such as cabinet committees). This personal approach also became identified with personal toughness at times, such as
3220-696: Is associated with libertarianism within the Conservative Party, albeit one of libertarian ends achieved by using strong leadership. British political commentator Andrew Marr has called libertarianism the "dominant, if unofficial, characteristic of Thatcherism". Whereas some of her heirs, notably Michael Portillo and Alan Duncan , embraced this libertarianism, others in the Thatcherite movement such as John Redwood sought to become more populist . Some commentators have argued that Thatcherism should not be considered properly libertarian. Noting
3335-405: Is because there are too few midwives. Neonatal mortality rose from 2.6 deaths for every 1,000 births in 2015 to 2.7 deaths per 1,000 births in 2016. Infant mortality (deaths during the first year of life) rose from 3.7 to 3.8 per 1,000 live births during the same period. Assaults on NHS staff have increased, there were 56,435 recorded physical assaults on staff in 2016–2017, 9.7% more than the 51,447
3450-650: Is not directly comparable with later figures. A 2012 analysis by the BBC estimated that the NHS across the whole UK has 1.7 million staff, which made it fifth on the list of the world's largest employers (well above Indian Railways). In 2015 the Health Service Journal reported that there were 587,647 non-clinical staff in the English NHS. 17% worked supporting clinical staff. 2% in cleaning and 14% administrative. 16,211 were finance staff. The NHS plays
3565-513: Is not necessarily a public administration, and its budget may be isolated from the main state budget. Some systems do not provide universal healthcare or restrict coverage to public health facilities. Some countries, such as Germany, have multiple public insurance organizations linked by a common legal framework. Some, such as the Netherlands and Switzerland , allow private for-profit insurers to participate. Almost every major country that has
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3680-440: Is provided through general taxation and not a specific tax. Because the NHS is not funded by a contributory insurance scheme in the ordinary sense and most patients pay nothing for their treatment there is thus no billing to the treated person nor any insurer or sickness fund as is common in many other countries. This saves hugely on administration costs that might otherwise involve complex consumable tracking and usage procedures at
3795-504: Is regularly revised – in 2003, the Government announced major changes to NHS dentistry, giving primary care trusts (PCTs) responsibility for commissioning NHS dental services in response to local needs, and using NHS contracts to influence where dental practices were located, and in 2006 a new contract was introduced following Department of Health recommendations on how to cash limit NHS primary care dentistry. Professional bodies such as
3910-615: Is the reason why in Great Britain in the mid 1980s the members of the top decile possessed more than a half of all the wealth. To justify this by means of economic "objectivities" would be an ideology. What is at play here are interests and power. The Conservative historian of Peterhouse , Maurice Cowling , also questioned the uniqueness of "Thatcherism". Cowling claimed that Thatcher used "radical variations on that patriotic conjunction of freedom, authority, inequality, individualism and average decency and respectability, which had been
4025-490: Is thus often compared to classical liberalism . Milton Friedman said that "Margaret Thatcher is not in terms of belief a Tory. She is a nineteenth-century Liberal ". Thatcher herself stated during a speech in 1983: "I would not mind betting that if Mr Gladstone were alive today he would apply to join the Conservative Party". In the 1996 Keith Joseph memorial lecture, Thatcher argued: "The kind of Conservatism which he and I [...] favoured would be best described as 'liberal', in
4140-495: Is to run away from the real decisions, practical responsibility and effective action. Thatcherism is associated with a conservative stance on morality . Sutcliffe-Braithwaite (2012) argues that Thatcherism married conservatism with free-market economics . Thatcherism did not propose dramatic new panaceas such as Milton Friedman's negative income tax . Instead, the goal was to create a rational tax-benefit economic system that would increase British efficiency while supporting
4255-630: The British Dental Association have complained that the 2006 contract changes introduced a remuneration system which fails to incentivize disease prevention, leading to declining patient outcomes and that radical reform was needed. NHS dentistry charges as of April 2017 were: £20.60 for an examination; £56.30 for a filling or extraction; and £244.30 for more complex procedures such as crowns, dentures, or bridges. As of 2007, less than half of dentists' income came from treating patients under NHS coverage; about 52% of dentists' income
4370-764: The Clement Attlee government's post-war reforms, there was continuous right-wing opposition in the lower ranks of the party, in right-wing pressure groups like the Middle Class Alliance and the People's League for the Defence of Freedom and later in think tanks like the Centre for Policy Studies . For example, in the 1945 general election , the Conservative Party chairman Ralph Assheton had wanted 12,000 abridged copies of The Road to Serfdom (a book by
4485-576: The Department of Health and Social Care made a non-binding recommendation that NHS staff in England should receive a 1% pay rise for 2021–2022, citing the 'uncertain' financial situation and the current low inflation. This is estimated to cost £500 million a year, as almost half of the NHS's budget goes on staffing costs (at £56.1 billion). The Trades Union Congress estimated that nurses' pay would be £2,500 less than in 2010, paramedics' pay would be £3,330 less and porters' pay would be £850 less due to inflation . The Royal College of Nursing has criticized
4600-669: The Department of Health and Social Care , the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR). Free healthcare at the point of use comes from the core principles at the founding of the National Health Service. The 1942 Beveridge cross-party report established
4715-527: The European Community to supersede British sovereignty. In a famous 1988 Bruges speech, Thatcher declared: "We have not successfully rolled back the frontiers of the state in Britain, only to see them reimposed at a European level, with a European superstate exercising a new dominance from Brussels". It is often claimed that the word Thatcherism was coined by cultural theorist Stuart Hall in
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4830-636: The Falklands War in 1982, the IRA bomb at the Conservative conference in 1984 and the miners' strike in 1984–85. Sir Charles Powell , the foreign affairs private secretary to the Prime Minister (1984–1991 and 1996), described her style as such: "I've always thought there was something Leninist about Mrs Thatcher which came through in the style of government: the absolute determination,
4945-571: The Institute for Fiscal Studies (IFS), compared to the increase necessary to keep up with a rising population that is also ageing, spending will fall by 1.3% from 2009–10 to 2019–20. George Stoye, senior research economist of the IFS, and said the annual increases since 2009-10 were "the lowest rate of increase over any similar period since the mid-1950s, since when the long-run annual growth rate has been 4.1%". This has led to cuts to some services, despite
5060-838: The NHS Scotland , HSC Northern Ireland and NHS Wales , which were run by the respective UK government ministries for each home nation before falling under the control of devolved governments in 1999. In 2009, NHS England agreed to a formal NHS constitution , which sets out the legal rights and responsibilities of the NHS, its staff, and users of the service, and makes additional non-binding pledges regarding many key aspects of its operations. The Health and Social Care Act 2012 came into effect in April 2013, giving GP-led groups responsibility for commissioning most local NHS services. Starting in April 2013, primary care trusts (PCTs) began to be replaced by general practitioner (GP)-led organizations called clinical commissioning groups (CCGs). Under
5175-599: The National Health Service (NHS), which was widely popular with the British public. In 1982, Thatcher promised that the NHS was "safe in our hands". The exact terms of what makes up Thatcherism and its specific legacy in British history over the past decades are controversial. Ideologically, Thatcherism has been described by Nigel Lawson , Thatcher's Chancellor of the Exchequer from 1983 to 1989, as
5290-548: The Nicholson challenge —which involved making £20 billion in savings across the service by 2015. The principal NHS website states the following as core principles: The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on 5 July 1948, it had at its heart three core principles: These three principles have guided
5405-462: The public sector borrowing requirement is held down by the ruse of subtracting the proceeds of privatisation as well as taxes from government expenditure. The principles of monetarism have been abandoned". Thatcherism is also associated with supply-side economics . Whereas Keynesian economics holds that the government should stimulate economic growth by increasing demand through increased credit and public spending, supply-side economists argue that
5520-475: The 1945 election, having just read Hayek's Road to Serfdom . [...] What brought the Tories to 13 years of political supremacy in 1951 was the slogan 'Set the people free'. [...] There is absolutely nothing new about the doctrinal front that she presents on these matters. [...] As for 'privatisation', Mr. Powell proposed it in [...] 1968. As for 'property-owning democracy', I believe it was Anthony Eden who coined
5635-612: The 1980s during her time as prime minister, the Thatcher government enacted Section 28 , a law that opposed the "intentional promotion" of homosexuality by local authorities and "promotion" of the teaching of "the acceptability of homosexuality as a pretended family relationship" in schools. In her 1987 speech to the Conservative Party conference, Thatcher stated: Children who need to be taught to respect traditional moral values are being taught that they have an inalienable right to be gay ... All of those children are being cheated of
5750-568: The 1980s, viewing past ideological views as "a mistake" with his ideological direction . Regarding feminism Thatcher said "The feminists hate me, don't they? And I don't blame them. For I hate feminism. It is poison" and "I owe nothing to Women's lib ". In May 1988, Thatcher gave an address to the General Assembly of the Church of Scotland . In the speech, Thatcher offered a theological justification for her ideas on capitalism and
5865-620: The Belgian government pays the bulk of the fees for dental and eye care, while the Australian government covers eye care but not dental care. Publicly funded medicine may be administered and provided by the government, as in the Nordic countries , Portugal , Spain , and Italy ; in some systems, though, medicine is publicly funded but most hospital providers are private entities, as in Canada. The organization providing public health insurance
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#17328016261645980-569: The Conservative Party held a dinner in London Hilton to honour the anniversary. During the dinner, several speeches were given. To Thatcher's astonishment, the Conservatives had decided that it was time to shelve the economic policies of the 1980s. The Conservative Party leader at the time, William Hague , said that the party had learnt its lesson from the 1980s and called it a "great mistake to think that all Conservatives have to offer
6095-590: The Conservative Party's theme since at least 1886". Cowling further contended that the "Conservative Party under Mrs Thatcher has used a radical rhetoric to give intellectual respectability to what the Conservative Party has always wanted". Historians Emily Robinson, Camilla Schofield, Florence Sutcliffe-Braithwaite and Natalie Thomlinson have argued that by the 1970s, Britons were keen on defining and claiming their individual rights, identities and perspectives. They demanded greater personal autonomy and self-determination and less outside control. They angrily complained that
6210-409: The House of Lords, an honour which William Ewart Gladstone , for instance, had declined. Thinkers closely associated with Thatcherism include Keith Joseph , Enoch Powell , Friedrich Hayek and Milton Friedman. In an interview with Simon Heffer in 1996, Thatcher stated that the two greatest influences on her as Conservative leader had been Joseph and Powell, who were both "very great men". Thatcher
6325-485: The Labour Party from 1983 to 1992, initiated Labour's rightward shift across the political spectrum by largely concurring with the economic policies of the Thatcher government. The New Labour governments of Tony Blair and Gordon Brown were described as "neo-Thatcherite" by some on the left since many of their economic policies mimicked those of Thatcher. In 1999, twenty years after Thatcher had come to power,
6440-500: The NHS is the Department of Health and Social Care , headed by the Secretary of State for Health and Social Care . The Department of Health and Social Care had a £110 billion budget in 2013–14, most of which was spent on the NHS. A. J. Cronin 's controversial novel The Citadel , published in 1937, had fomented extensive debate about the severe inadequacies of healthcare. The author's innovative ideas were not only essential to
6555-406: The NHS must claim back the cost of treatment, and ambulance services, for those who have been paid personal injury compensation. In the last year of the scheme immediately preceding 2007, over £128 million was reclaimed. From April 2019 £725 is payable for outpatient treatment, £891 per day for inpatient treatment and £219 per ambulance journey. Publicly funded health care The fund may be
6670-414: The NHS' 70th Anniversary then Prime Minister Theresa May announced extra funding for the NHS worth an average real terms increase of 3.4% a year, reaching £20.5 billion extra in 2023/24. Jeremy Hunt describes the process of setting the NHS budget as far too random - "decided on the back of headlines, elections and anniversaries rather than on rational calculations of demand and cost." From 2003 to 2013
6785-402: The NHS. The position of dentistry within the NHS has been contested frequently. At the inception of the NHS, three branches of dental service were established: local health authority dental service; general practitioner service; and hospital dental service. Dental treatment was initially free at the point of use; however charges were introduced in 1951 for dentures – leading to the resignation of
6900-417: The NHS. The white paper, Equity and excellence: liberating the NHS , with implications for all health organizations in the NHS abolishing primary care trusts and strategic health authorities . It claimed to shift power from the center to GPs and patients, moving somewhere between £60 and £80 billion into the hands of clinical commissioning group to commission services. The bill became law in March 2012 with
7015-402: The NHS. They may operate in partnership with other professionals, own and operate their surgeries and clinics, and employ their staff, including other doctors, etc. However, the NHS does sometimes provide centrally employed healthcare professionals and facilities in areas where there is insufficient provision by self-employed professionals. Note that due to methodological changes, the 1978 figure
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#17328016261647130-626: The Thatcherites arguing for stricter inflation control. The Labour Chancellor Denis Healey had already adopted some monetarist policies, such as reducing public spending and selling off the government's shares in BP . Moreover, it has been argued that the Thatcherites were not strictly monetarist. A common theme centres on the Medium Term Financial Strategy, issued in the 1980 budget, which consisted of targets for reducing
7245-729: The United States because of Americans' lacking health insurance, equivalent to one excess death every 12 min. More broadly, the total number of people in the United States, whether insured or uninsured, who die because of lack of medical care was estimated in a 1997 analysis to be nearly 100,000 per year. Thatcherism Defunct [REDACTED] Thatcherism is a form of British conservative ideology named after Conservative Party leader Margaret Thatcher that relates to not just her political platform and particular policies but also her personal character and style of management while in office. Proponents of Thatcherism are referred to as Thatcherites . The term has been used to describe
7360-787: The actual cost of the medicines through NHS Prescription Services, a division of the NHS Business Services Authority. As of March 2023 the NHS prescription charge in England was £9.35 per item (in Scotland, Wales and Northern Ireland there is no charge for items prescribed on the NHS). People over sixty, children under sixteen (or under nineteen if in full-time education), patients with certain medical conditions, and those with low incomes, are exempt from charges, subject to penalties for claiming exemption when not entitled. Those who require repeated prescriptions may purchase
7475-473: The amount of the subsidy. Under older legislation (mainly the Road Traffic Act 1930 ) a hospital treating the victims of a road traffic accident was entitled to limited compensation (under the 1930 Act before any amendment, up to £25 per person treated) from the insurers of driver(s) of the vehicle(s) involved, but were not compelled to do so and often did not do so; the charge was in turn covered by
7590-443: The anti-socialist economist Friedrich Hayek later closely associated with Thatcherism), taking up one-and-a-half tons of the party's paper ration, distributed as election propaganda. The historian Christopher Cooper traced the formation of the monetarist economics at the heart of Thatcherism back to the resignation of the Conservative chancellor of the Exchequer, Peter Thorneycroft , in 1958. As early as 1950, Thatcher accepted
7705-459: The architect of the NHS and Minister for Labour, Aneurin Bevan in March 1951 – and in 1952 for other treatments. Dentists are private contractors to the NHS, which means practitioners must purchase and maintain the practice premises, equip the surgery, and hire staff to provide an NHS dental service. The contract between the NHS and dentists determines what work is provided for under the NHS, payments to dentists, and charges to patients. The contract
7820-520: The armed forces. Most NHS staff, including non-clinical staff and GPs (although most GPs are self-employed), are eligible to join the NHS Pension Scheme —which, from 1 April 2015, is an average-salary defined-benefit scheme. Among the current challenges with recruiting staff are pay, work pressure, and difficulty recruiting and retaining staff from EU countries due to Brexit . and there are fears that doctors could also leave. In March 2021,
7935-418: The belief that there's a vanguard which is right and if you keep that small, tightly knit team together, they will drive things through ... there's no doubt that in the 1980s, No. 10 could beat the bushes of Whitehall pretty violently. They could go out and really confront people, lay down the law, bully a bit". By 1987, after Thatcher's successful third re-election, criticism of Thatcherism increased. At
8050-539: The conception of the NHS but in fact, his best-selling novels are said to have greatly contributed to the Labour Party's victory in 1945. A national health service was one of the fundamental assumptions in the Beveridge Report . The Emergency Hospital Service established in 1939 gave a taste of what a National Health Service might look like. Healthcare before the war had been an unsatisfactory mix of private, municipal, and charity schemes. Bevan decided that
8165-495: The consensus of the day about the welfare state, claiming the credit belonged to the Conservatives in a speech to the Conservative Association annual general meeting. Biographer Charles Moore states: Neither at the beginning of her career nor when she was prime minister, did Margaret Thatcher ever reject the wartime foundations of the welfare state, whether in health, social policy or education. In this she
8280-487: The development of the NHS for more than half a century and remain. However, in July 2000, a full-scale modernization program was launched and new principles were added. The main aims of the additional principles are that the NHS will: The English NHS is controlled by the UK government through the Department of Health and Social Care (DHSC), which takes political responsibility for the service. Resource allocation and oversight
8395-663: The end of 1990. While credited with reviving Britain's economy, Thatcher also was blamed for spurring a doubling of the relative poverty rate. Britain's childhood-poverty rate in 1997 was the highest in Europe. When she resigned in 1990, 28% of the children in Great Britain were considered to be below the poverty line , a number that kept rising to reach a peak of nearly 30% during the government of Thatcher's successor, John Major . During her government, Britain's Gini coefficient reflected this growing difference, going from 0.25 in 1979 to 0.34 in 1990, at about which value it remained for
8510-467: The establishment was withholding it. They argue that this shift in concerns had helped cause Thatcherism and was incorporated into its appeal. Critics of Thatcherism claim that its successes were obtained only at the expense of great social costs to the British population. There were nearly 3.3 million unemployed in Britain in 1984, compared to 1.5 million when she first came to power in 1979, though that figure had reverted to 1.6 million by
8625-543: The fear of the too-powerful state that had troubled Hayek. Norman Tebbit , a close ally of Thatcher, laid out in a 1985 lecture what he thought to be the permissive society that conservatives should oppose: Bad art was as good as good art. Grammar and spelling were no longer important. To be clean was no better than to be filthy. Good manners were no better than bad. Family life was derided as an outdated bourgeois concept. Criminals deserved as much sympathy as their victims. Many homes and classrooms became disorderly; if there
8740-545: The full breadth of critical and non-critical medical care, without payment except for some specific NHS services, for example eye tests , dental care , prescriptions and aspects of long-term care . These charges are usually lower than equivalent services provided by a private provider and many are free to vulnerable or low-income patients. The NHS provides the majority of healthcare in England, including primary care , in-patient care , long-term healthcare , ophthalmology and dentistry . The National Health Service Act 1946
8855-439: The functioning of the free economy". Several commentators have traced the origins of Thatcherism in post-war British politics. The historian Ewen Green claimed there was resentment of the inflation, taxation and the constraints imposed by the labour movement, which was associated with the so-called Buttskellite consensus in the decades before Thatcher came to prominence. Although the Conservative leadership accommodated itself to
8970-543: The government should instead intervene only to create a free market by lowering taxes, privatising state industries and increasing restraints on trade unionism. Reduction in the power of the trades unions was made gradually, unlike the approach of the Edward Heath government, and the most significant single confrontation with the unions was the National Union of Mineworkers (NUM) strike of 1984–1985, in which
9085-502: The growth of the money supply in the following years. After overshooting many of these targets, the Thatcher government revised the targets upwards in 1982. Analysts have interpreted this as an admission of defeat in the battle to control the money supply. The economist C. F. Pratten claimed that "since 1984, behind a veil of rhetoric, the government has lost any faith it had in technical monetarism. The money supply, as measured by M3 , has been allowed to grow erratically, while calculation of
9200-506: The health and social care workers. Secretary of State for Health and Social Care Matt Hancock and Secretary of State for Education Gavin Williamson similarly argued that the decision was due to an assessment of what was affordable due to the pandemic and that NHS staff was excluded from a wider public sector pay freeze. Shadow Secretary of State for Health and Social Care Jon Ashworth clarified that Labour would "honour whatever
9315-476: The industrial and economic reforms of the Thatcher period" and as well that "much of what she wanted to do in the 1980s was inevitable, a consequence not of ideology but of social and economic change." [A] mixture of free markets , financial discipline , firm control over public expenditure , tax cuts , nationalism , " Victorian values " (of the Samuel Smiles self-help variety ), privatisation and
9430-473: The land that is a luxury that only the complacent can afford". Although the term had been widely used before then, not all social critics have accepted the term as valid, with the High Tory journalist T. E. Utley believing "There is no such thing as Thatcherism". Utley contended that the term was a creation of Thatcher's enemies who wished to damage her by claiming that she had an inflexible devotion to
9545-496: The market economy. She said, "Christianity is about spiritual redemption, not social reform", and she quoted St. Paul by saying, "If a man will not work he shall not eat". Choice played a significant part in Thatcherite reforms, and Thatcher said that choice was also Christian, stating that Jesus Christ chose to lay down his life and that all individuals have the God-given right to choose between good and evil . Whilst Thatcher
9660-471: The miners' union was eventually defeated. Evidence shows that the Conservative Party and the NUM anticipated this confrontation with the trade unions. The outcome contributed to the resurgence of the power of capital over labour . All too often the ills of this country are passed off as those of society. Similarly, when action is required, society is called upon to act. But society as such does not exist except as
9775-564: The new system, a new NHS Commissioning Board, called NHS England , oversees the NHS from the Department of Health . The Act has also become associated with the perception of increased private provision of NHS services. In reality, the provision of NHS services by private companies long precedes this legislation, but there are concerns that the new role of the healthcare regulator ('Monitor') could lead to increased use of private-sector competition, balancing care options between private companies, charities, and NHS organizations. NHS trusts responded to
9890-527: The next 20 years, under both Conservative and Labour governments. The extent to which one can say Thatcherism has a continuing influence on British political and economic life is unclear. It could be said that a "post-Thatcherite consensus" exists in modern British political culture, especially regarding monetary policy. In the 1980s, the now defunct Social Democratic Party adhered to a "tough and tender" approach in which Thatcherite reforms were coupled with additional welfare provisions. Neil Kinnock , leader of
10005-442: The old-fashioned sense. And I mean the liberalism of Mr Gladstone, not of the latter day collectivists ". Thatcher once told Friedrich Hayek : "I know you want me to become a Whig; no, I am a Tory". Hayek believed "she has felt this very clearly". The relationship between Thatcherism and liberalism is complicated. Thatcher's former defence secretary John Nott claimed that "it is a complete misreading of her beliefs to depict her as
10120-444: The overall increase in funding. In 2017, funding increased by 1.3% while demand rose by 5%. Ted Baker, Chief Inspector of Hospitals has said that the NHS is still running the model it had in the 1960s and 1970s and has not modernised due to lack of investment. The British Medical Association (BMA) has called for £10bn more annually for the NHS to get in line with what other advanced European nations spend on health. In June 2018 ahead of
10235-399: The party conference that her third term was to be about 'social affairs'. During her last three years in power, she attempted to reform socialised welfare, differing from her earlier stated goal of "rolling back the state". Thatcherism is associated with the economic theory of monetarism , notably put forward by Friedrich Hayek 's The Constitution of Liberty which Thatcher had banged on
10350-510: The patient level and concomitant invoicing, reconciliation, and bad debt processing. Eligibility for NHS services is based on having ordinary resident status , regardless of nationality. Prescriptions for medication in England and Wales are subject to a fixed charge per item for up to three months' supply, regardless of the actual cost of the medicine. Some people qualify for free prescriptions. Higher charges apply to medical appliances. Pharmacies or other dispensing contractors are reimbursed for
10465-419: The pay rise, calling it 'pitiful' and said that nurses should be getting 12.5% more; it has also agreed to set up a £35m fund to support members in the event of a strike. Other unions have threatened strike actions and warned that the proposal could lead to staff quitting their jobs, worsening staffing issues. The Labour Party similarly criticized the proposal as 'reprehensible' and claimed that it goes against
10580-426: The phrase. In foreign policy, Utley claimed Thatcher's desire to restore British greatness did not mean "primarily a power devoted to the preservation of its own interests" but that she belonged "to that militant Whig branch of English Conservatism...her view of foreign policy has a high moral content". In practical terms, he claimed this expressed itself in her preoccupation with "the freedom of Afghanistan rather than
10695-417: The point of use. This means that people generally do not pay anything for their doctor visits, nursing services, surgical procedures or appliances, consumables such as medications and bandages, plasters, medical tests, and investigations, x-rays, CT or MRI scans, or other diagnostic services. Hospital inpatient and outpatient services are free, both medical and mental health services. Funding for these services
10810-483: The population of England increased by about 6%. The number of patients admitted to hospital in an emergency went up by 15%. There were 542,435 emergency hospital admissions in England in October 2018, 5.8% more than in October 2017. Health spending in England is expected to rise from £112 billion in 2009/10 to £127 billion in 2019/20 (in real terms), and spending per head will increase by 3.5%. However, according to
10925-463: The principal fundholders in the NHS system were the primary care trusts (PCTs), which commissioned healthcare from NHS trusts , GPs, and private providers. PCTs disbursed funds to them on an agreed tariff or contract basis, on guidelines set out by the Department of Health. The PCTs budget from the Department of Health was calculated on a formula basis relating to population and specific local needs. They were supposed to "break-even" – that is, not show
11040-547: The principles of the British government under Thatcher from the 1979 general election to her resignation in 1990 . In international terms, Thatcherites have been described as a part of the general socio-economic movement known as neoliberalism , with different countries besides the United Kingdom (such as the United States) sharing similar policies around expansionary capitalism . Thatcherism represents
11155-543: The principles of the NHS which was implemented by the Labour government in 1948. Labour's Minister for Health Aneurin Bevan is popularly considered the NHS's founder, despite never formally being referred to as such. In practice, "free at the point of use" normally means that anyone legitimately and fully registered with the system (i.e. in possession of an NHS number ), available to legal UK residents regardless of nationality (but not non-resident British citizens), can access
11270-598: The programme of the next non-Conservative government, with Tony Blair 's " New Labour " organisation governing the nation throughout the 1990s and 2000s, basically accepted the central reform measures of Thatcherism such as deregulation , privatisation of key national industries, maintaining a flexible labour market , marginalising the trade unions and centralising power from local authorities to central government. While Blair distanced himself from certain aspects of Thatcherism earlier in his career, in his 2010 autobiography A Journey , he argued both that "Britain needed
11385-430: The review body recommends". At the end of 2021, there were 99,000 vacancies in the English NHS. 39,000 more nurses were needed, together with 1,400 more anesthetists, 1,900 more radiologists, and 2,500 more GPs. Miriam Deakin of NHS Providers stated there were 133,000 NHS vacancies in late 2022. The coalition government's white paper on health reform, published in July 2010, set out a significant reorganization of
11500-399: The right balance of public and private insurance, public subsidies, and out-of-pocket payments. Many OECD countries have implemented reforms to achieve policy goals of ensuring access to health care, improving the quality of health care and health outcomes, allocating an appropriate level of public sector other resources to healthcare but at the same time ensuring that services are provided in
11615-437: The security of Ulster". Such leftist critics as Anthony Giddens claim that Thatcherism was purely an ideology and argue that her policies marked a change which was dictated more by political interests than economic reasons: Rather than by any specific logic of capitalism, the reversal was brought about by voluntary reductions in social expenditures, higher taxes on low incomes and the lowering of taxes on higher incomes. This
11730-458: The tendency towards strong central government in matters concerning the trade unions and local authorities, Andrew Gamble summarised Thatcherism as "the free economy and the strong state". Simon Jenkins accused the Thatcher government of carrying out a nationalisation of Britain. Libertarian political theorist Murray Rothbard did not consider Thatcherism to be libertarian and heavily criticised Thatcher and Thatcherism, stating that "Thatcherism
11845-431: The then legally required element of those drivers' motor vehicle insurance (commonly known as Road Traffic Act insurance when a driver held only that amount of insurance). As the initial bill went to the driver rather than the insurer, even when a charge was imposed it was often not passed on to the liable insurer. It was common to take no further action in such cases, as there was no practical financial incentive (and often
11960-495: The time, Thatcher claimed it was necessary to tackle the "culture of dependency" by government intervention to stop socialised welfare. In 1988, she caused controversy when she made the remarks, "You do not blame society. Society is not anyone. You are personally responsible" and, "Don't blame society – that's no one." These comments attracted significant criticism, including from other conservatives due to their belief in individual and collective responsibility. In 1988, Thatcher told
12075-403: The time. In the 1980s, Thatcherism represented a systematic, decisive rejection and reversal of the post-war consensus , wherein the major political parties largely agreed on the central themes of Keynesianism , the welfare state, the mixed economy, supplies both of public and private housing and close regulation of the economy. There was one major exception: the National Health Service, which
12190-465: The way forward was a national system rather than a system operated by local authorities. He proposed that each resident of the UK would be signed up to a specific General Practice (GP) as the point of entry into the system, building on the foundations laid in 1912 by the introduction of National Insurance and the list system for general practice. Patients would have access to all medical, dental, and nursing care they needed without having to pay for it at
12305-703: The year before. Low staffing levels and delays in patients being treated are blamed for this. Nearly all hospital doctors and nurses in England are employed by the NHS and work in NHS-run hospitals, with teams of more junior hospital doctors (most of whom are in training) being led by consultants , each of whom is trained to provide expert advice and treatment within a specific specialty. From 2017, NHS doctors must reveal how much money they make from private practice. General practitioners , dentists, optometrists (opticians), and other providers of local health care are almost all self-employed and contract their services back to
12420-456: Was a strong critic of communism , Marxism and socialism . Biographer John Campbell reports that in July 1978, when asked by a Labour MP in Commons what she meant by socialism, "she was at a loss to reply. What in fact she meant was Government support for inefficient industries, punitive taxation, regulation of the labour market, price controls – everything that interfered with
12535-773: Was delegated to NHS England , an arms-length body, by the Health and Social Care Act 2012 . NHS England commissions primary care services (including GPs ) and some specialist services, and allocates funding to 211 geographically based clinical commissioning groups (CCGs) across England. The CCGs commission most services in their areas, including hospital and community-based healthcare. Several types of organizations are commissioned to provide NHS services, including NHS trusts and private sector companies. Many NHS trusts have become NHS foundation trusts , giving them an independent legal status and greater financial freedoms. The following types of NHS trusts and foundation trusts provide NHS services in specific areas: Some services are provided at
12650-504: Was enacted on 5 July 1948. Private health care has continued parallel to the NHS, paid for largely by private insurance: it is used by about 8% of the population, generally as an add-on to NHS services. The NHS is largely funded from general taxation, with a small amount being contributed by National Insurance payments and from fees levied by recent changes in the Immigration Act 2014 . The UK government department responsible for
12765-650: Was from treating private patients. From 1 April 2024, the NHS Sight Test Fee (in England) was £23.53, and there were 13.1 million NHS sight tests carried out in the UK. For those who qualify through need, the sight test is free, and a voucher system is employed to pay for or reduce the cost of lenses. There is a free spectacles frame and most opticians keep a selection of low-cost items. For those who already receive certain means-tested benefits, or who otherwise qualify, participating opticians use tables to find
12880-464: Was less radical than her critics or some of her admirers supposed. Her concern was to focus more on abuse of the system, on bureaucracy and union militancy, and on the growth of what later came to be called the dependency culture, rather than on the system itself. Historian Richard Vinen is sceptical about there being Thatcherism before Thatcher. Thatcher saw herself as creating a libertarian movement, rejecting traditional Toryism . Thatcherism
12995-422: Was neither right nor wrong there could be no basis for punishment or reward. Violence and soft pornography became accepted in the media. Thus was sown the wind; and we are now reaping the whirlwind. Despite her association with social conservatism , Thatcher voted in 1966 to legalise homosexuality, one of the few Conservative MPs to do so. That same year, she also voted in support of legal abortion. However, in
13110-603: Was prime minister, she greatly embraced transatlantic relations with US president Ronald Reagan . She often publicly supported Reagan's policies even when other Western allies were not as vocal. For example, she granted permission for American planes to use British bases for raids, such as the 1986 United States bombing of Libyan Arab Jamahiriya , and allowed American cruise missiles and Pershing missiles to be housed on British soil in response to Soviet deployment of SS-20 nuclear missiles targeting Britain and other Western European nations. While Euroscepticism has for many become
13225-417: Was widely popular and had wide support inside the Conservative Party. In 1982, Prime Minister Margaret Thatcher promised Britons that the NHS is "safe in our hands." The NHS was established within the differing nations of the United Kingdom through differing legislation, and as such there has never been a singular British healthcare system, instead there are 4 health services in the United Kingdom; NHS England,
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