Britain's Biggest Enterprise
Last Updated: August, 2019
Left: Oliver Letwin. Right: John Redwood. Centre: A young Oliver Letwin in 1992 - A letter to Margaret Thatcher in 1983 recommended Letwin to her as a 'particularly mature as well as intelligent man' who would make a good government special adviser.

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.

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 the process of privatising the NHS, blueprints that have been turned into policy. 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:
  1. Establishment of the NHS as an independent trust.
  2. Increased use of joint ventures between the NHS and the private sector.
  3. Extending the principle of charging.
  4. A system of 'health credits'.
  5. A national health insurance scheme.