 The Health and Social Care Act 2012 was intended to open up the internal market to external competition.The 2019 NHS Long Term Plan called for the establishment of integrated care systems across England by 2021, effectively ending the internal market.Although the Thatcher government was slow to reform the NHS, following the 1983 Griffiths report, from 1988 it began to apply the principles of New Public Management vigorously across the welfare state.