In the spring of 1989, a four-person dinner was held in a private room at the Carlton Club, a Conservative private members’ organisation in St James’s, central London. The key protagonists were Kenneth Clarke, the secretary of state for health in Margaret Thatcher’s government, and Dr John Marks, chair of council of the doctors’ trade union, the British Medical Association, who has died aged 97.
At issue were Clarke’s plans for the most radical restructuring of the National Health Service in its 40-year history, which went on to introduce the purchaser/provider split in 1991. Health authorities were to cease to be the NHS managers. Instead, they, along with those GPs who volunteered, were to purchase NHS care – buying it in from NHS hospitals who were to operate more independently, competing with each other, and indeed with the private sector, for the purchasers’ business.
