Downing Street Years - Margaret Thatcher [375]
The September 1990 discussion with Chris Patten and Michael Spicer was not an inspiring one. Michael was keen to concentrate on new measures to revive the private rented sector. I agreed with him on this, but I thought that in the short term it was more important to tackle the problems of public sector housing. Chris, I suspect, thought that the best way of doing this was simply to build more public sector houses. In any case, he seemed content to work within the present local authority dominated framework. After the meeting I had a discussion with my advisers and penned a personal minute to Chris Patten in which I noted my disappointment. I added:
I am not persuaded that we are yet being sufficiently bold in carrying forward promising and practical policy initiatives in the short term; nor have we yet explored with the necessary thoroughness and vision the full range of policy options for the longer term.
I drew particular attention to the importance of extending home ownership through the ‘Right to Buy’, ‘Rents to Mortgages’ and home-steading — providing people with the money to renovate and then become the owners of derelict properties. I reaffirmed that I wanted to get local authorities out of managing and owning housing. It was clear to me that we must now get back to the kind of fundamental policy thinking which Nick Ridley — now no longer a member of the Government — had once supplied. I said that I was going to call in outside experts and businessmen to talk through all these issues at a dinner which Chris would, of course, attend; but I had left No. 10 before the planned dinner could take place. The inertia of the DoE had won out in the end.
REFORMING THE NATIONAL HEALTH SERVICE (NHS)
Housing, like Education, had been at the top of the list for reform in 1987. But I had reserved Health for detailed consideration later. I believed that the NHS was a service of which we could genuinely be proud. It delivered a high quality of care — especially when it came to acute illnesses — and at a reasonably modest unit cost, at least compared with some insurance-based systems. Yet there were large and on the face of it unjustifiable differences between performance in one area and another. Consequently, I was much more reluctant to envisage fundamental changes than I was in the nation’s schools. Although I wanted to see a flourishing private sector of health alongside the National Health Service, I always regarded the NHS and its basic principles as a fixed point in our policies. And so, whereas I felt under no obligation to defend the performance of our schools when criticism was made, I peppered my speeches and interviews with the figures for extra doctors, dentists and midwives, patients treated, operations performed and new hospitals built. I felt that on this record we ought to be able to stand our ground.
Some of the political difficulties we faced on the Health Service could be put down to exploitation of hard cases by Opposition politicians and the press. But there was, of course, more to it than that. There was bound to be a potentially limitless demand for health care (in the broadest sense) for as long as it was provided free at the point of delivery. The number of elderly people — the group who made greatest call on the NHS — was increasing and this added to the pressure. Advances in medicine opened up the possibility of- and demand for — new and often expensive forms of treatment.
In significant ways, the NHS lacked the right economic signals to respond to these pressures. Dedicated its staff generally were; cost conscious they were