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Enoch Powell was appointed Minister of Health by Harold Macmillan in July 1960, before being promoted to the position of Cabinet Minister in 1962. This was seen as a political manoeuvre from a Prime Minister who was hardly well disposed towards Powell. He thus planned to both prevent him from attacking the government with his free market beliefs in the years of the implementation of the Middle Way and put him in a difficult position at the head of a costly department. Powell attempted to leave his mark on it and break with his predecessors’ policies: he intended to streamline NHS spending, while at the same time modernising and humanising the NHS through the introduction of an ambitious Hospital Plan. Powell was convinced that the NHS could be modernised. He believed that the latter should remain in the public domain but at the same time supported private health investment. This paper analyses Powell’s iconoclastic approach by using primary sources from Kew’s national archives and the Powell Papers from Cambridge. In order to enhance historiographical debates, the analysis will focus on three particular points: Powell’s handling of the cost of drugs, cigarette advertising and the fluoridation of water. These issues reveal an additional dilemma that Powell had to face: to what extent could freedom of choice be introduced into a public health service in which the State was the main driver?