In the spring of 1989, a four-person dinner was held in a private room at the Carlton Club, a Conservative private members’ organisation in St James’s, central London. The key protagonists were Kenneth Clarke, the secretary of state for health in Margaret Thatcher’s government, and Dr John Marks, chair of council of the doctors’ trade union, the British Medical Association, who has died aged 97. At issue were Clarke’s plans for the most radical restructuring of the National Health Service in its 40-year history, which went on to introduce the purchaser/provider split in 1991. Health authorities were to cease to be the NHS managers. Instead, they, along with those GPs who volunteered, were to purchase NHS care – buying it in from NHS hospitals who were to operate more independently, competing with each other, and indeed with the private sector, for the purchasers’ business. To Marks this somewhat more market-like approach would, at best, destabilise the service. At worst it looked like Americanisation, and preparation for potential privatisation. Clarke’s plans, the BMA argued, were “laying the groundwork for its future dismantlement”. At the dinner, in a form of peace-offering, Marks urged Clarke to introduce these changes initially in a single NHS region, to see how they went. Clarke replied with a grin: “If I do that, you buggers will sabotage it.”
Clarke had warned his Cabinet colleagues that his plans involved “smashing most of the tablets of stone” on the BMA’s doorstep, and that it would mount “one hell of a campaign”. Indeed it did. The association spent £3m on 11m pamphlets and 40,000 memorable posters. They included a picture of a steamroller captioned simply “Mrs Thatcher’s Plans for the NHS”, and another with the line: “What do you call a man who ignores medical advice? Mr Clarke” – the personal attack being the one element of the campaign that Marks came to regret. The eventual changes produced neither the best that their advocates hoped for nor the worst that their opponents feared. Though the BMA was defeated, in the eyes of many it emerged as the NHS’s great defender. It had not always been thus. Indeed, Marks was a leading light of the generation that moved the BMA to being one of the service’s staunchest advocates, after many of its members had remained, at best, sceptical in the years following its foundation after the second world war. A warm, funny, liberal, opinionated and compassionate man, he could be stubborn, but also, on occasion, genuinely self-critical. Perhaps his greatest achievement as the BMA’s chair during the turbulent years of 1984 to 1990 lay in fearlessly taking on an appreciable element within the organisation over repeated calls for the secret, even compulsory, testing of patients for HIV/Aids – the new, lethal and then untreatable condition having caused much terror. His media appearances, and the launch of the BMA’s own Foundation for Aids, did much to educate an alarmed public and an at times equally alarmed profession about the realities of the risk of HIV infection, while tackling its social stigma.
Born in London, John came from a colourful family of Jewish tailors, poulterers and publicans, the last being the profession of his father, Lewis. His mother, Rose (nee Goldbaum), was a photographer’s assistant and model. A natural rebel, John went to Tottenham county school and was evacuated during the second world war. He qualified as a doctor from Edinburgh University on the very day that the NHS came into operation in July 1948. After national service in the Royal Army Medical Corps (1949-51), in 1954 he both became a GP in Borehamwood, Hertfordshire, and married Dr Shirley Nathan, who joined the practice at the same time. They had three children, Richard, Helen and Laura. He found himself drawn into medical politics, and rising through the ranks of the BMA. The controversies in which he had a hand started with the GPs’ new deal in the 1960s, which rescued general practice: “I was regarded as a communist by one of my local colleagues because of my support for the NHS,” Marks recalled. He went on to be involved with defence of the abortion law, support for prescribing the pill to under-16s and the revolt over and eventual reform of the General Medical Council, the doctors’ regulatory body, in the 1970s. His strong opinions and passionate advocacy could make enemies. But he was so engaging that many who disagreed with him still wished to count him as a friend. And he had a hinterland – philately, bridge and family. He was still leading a University of the Third Age course not long before his death and whizzing a very small great-grandson around Finchley on his mobility scooter. In retirement he produced an engaging autobiography: The NHS: Beginning Middle and End? (2008). This charted his many battles, told of the best and worst of the early days of the NHS, and cleaved to his view that the 1991 reforms were the beginning of its end. He could never quite acknowledge the possibility that he and Clarke both believed that they had the best interests of the service at heart. He is survived by Shirley, his children and eight grandchildren. • John Henry Marks, general practitioner and medical representative, born 30 May 1925; died 20 September 2022