In 1988 MP Oliver Letwin co-authored a paper with John Redwood outlining the steps required to privatise the NHS. In many ways NHS privatisation had already started with the Griffiths Report , so
Britain's Biggest Enterprise was by no means the first or only attempt to sketch out a privatisation strategy for the NHS, but it seen by many as the main blueprint for all that has followed.
It was published around the same time as a
review of the NHS by the Thatcher government, which was shortly followed by the National Health Service and Community Care Act . You might say that
Britian's Biggest Enterprise is to the 'NHS and Community Care Act' as the white paper Equity and Excellence: Liberating the NHS is to the 2012 Health and Social Care Act . Papers such as
Britain's Biggest Enterprise and
Liberating the NHS articulate visions that form a blueprint for subsequent legislation that enables the privatisation the NHS. The real significance of these documents today is that they demonstrate some of the thinking - the conscious planning - that was required to set about fragmenting and transforming the NHS. Such documents stand as further evidence that NHS privatisation was not a response to naturally changing circumstances, it was not inevitable, but planned by ideologues.
Following the succession of David Cameron by Theresa May, Polly Toynbee noted that:
Cameron's shadowy thought tutor, Oliver Letwin, the Ayn Rand admirer and intellectual powerhouse behind anti-statism, must have known he would walk the plank from the cabinet office. But don't assume his ideas walk with him.
The following extract sums up Oliver Letwin's and John Redwood's ideas:
The range of options which needs to be considered is itself a matter for considerable debate. It should include as a minimum:
- Establishment of the NHS as an independent trust.
- Increased use of joint ventures between the NHS and the private sector.
- Extending the principle of charging.
- A system of 'health credits'.
- A national health insurance scheme.