1990's
The ‘Internal Market’ was introduced in the NHS following the passing of the 1990 NHS and Community Care Act. The ‘Internal Market’ or ‘Purchaser/Provider Split’, as it was also known, further introduced business and market principles into the organisation and delivery of health services.
District Health Authorities and the newly established GP Fundholders were to act as the purchasers in the system and to negotiate contracts with providers of health services. Providers of services were predominantly NHS Trusts which were also established at this point. NHS Trusts included hospital, community and mental health/learning disability services.
Providers could also include the private, not for profit and voluntary sectors although in practice most services were provided by NHS Trusts. Family Health Services Authorities replaced the Family Practitioner Committees but with similar responsibilities for the contractual arrangements of doctors, dentists, pharmacists and opticians.
In 1996 the ‘Fresh Start’ document in Wales merged the District Health Authorities and Family Health Services Authorities into 5 Health Authorities covering the whole of Wales.
In 1997 a Labour Government was elected to the UK Parliament. In January 1998 the Secretary of State for Wales published ‘Putting Patients First’. In England the Secretary of State for Health had previously published ‘The New NHS: Modern and Dependable’. Although the split between commissioners and providers of healthcare remained GP Fundholding was abolished with the primary care focus on commissioning shifting to the newly established Local Health Groups which were part of the 5 Health Authorities.
1998 saw the publication of ‘Better Health Better Wales’ which explicitly made the link between poverty and ill-health. The last year of the 1990s also saw the fruits of devolution in the establishment of the National Assembly for Wales.
