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Bulletin of Nizhnevartovsk State University
Journals / Bulletin of Nizhnevartovsk State University / Issue 3, 2026 / THE IMPACT OF THE NATIONAL HEALTH SERVICE AND COMMUNITY CARE ACT 1990 ON NEGATIVE TRENDS IN THE BRITISH HEALTHCARE SYSTEM
VAK Russia 5.6.2 UDC 9 CSCSTI 03.09 Russian Library and Bibliographic Classification 63 BISAC HIS UDC 94 CSCSTI 03.91

THE IMPACT OF THE NATIONAL HEALTH SERVICE AND COMMUNITY CARE ACT 1990 ON NEGATIVE TRENDS IN THE BRITISH HEALTHCARE SYSTEM

Published in Bulletin of Nizhnevartovsk State University · Issue 3, 2026 · Pages 49–63 · Rubric: General History
DOI: https://doi.org/10.36906/2311-4444/26-3/04
Received: 22.06.2026 Accepted: 21.09.2026 Published: 25.09.2026
Authors
DE
Denis Tkachuk
ORCID
ABSTRACT
The article analyses the impact of the National Health Service and Community Care Act 1990 on the formation of structural dysfunctions within the British healthcare system. Enacted under the dominance of neoliberal ideology during the governments of Margaret Thatcher and John Major, the Act legislatively enshrined the principles of the “internal market” and the purchaser–provider split, fundamentally transforming the institutional architecture of the National Health Service (NHS). The study aims to identify causal connections between the legislative introduction of the NHS “internal market” and the emergence of persistent negative trends: fragmentation of medical care, the formation of a two-tier system of access to services, a dramatic rise in administrative costs, financial destabilisation of NHS Trusts, and the systemic underfunding of long-term community care. The research methodology encompasses the historical-genetic method, systematic analysis of primary legislative sources (House of Commons, UK Government, and parliamentary debates — Hansard), as well as critical cross-referencing of academic historiography produced by Russian and international specialists in British studies. The source base comprises official UK government documents, parliamentary materials, peer-reviewed publications, and monographs by leading analysts in the field. The study establishes that, contrary to the declared goals of improving efficiency and expanding patient choice, the 1990 reform generated persistent institutional contradictions that were structurally inherent in the very conceptual design of the Act. The author’s hypothesis holds that it was precisely the 1990 reform that created the institutional architecture whose dismantling required three decades of successive legislative revision.
KEYWORDS
National Health Service and Community Care Act 1990; NHS; internal market; NHS Trusts; GP Fundholding; postcode lottery; Margaret Thatcher; John Major; health policy; United Kingdom.
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