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Structural reorganisation and policy

Department of Health and Social Security

In 1968, Richard Crossman, who had been associated with Bevan in resisting change to the National Health Service (NHS), replaced Kenneth Robinson, becoming head of a new Department of Health and Social Security (DHSS). He abandoned Robinson's scheme on the grounds that the proposed area boards were too small to achieve efficiencies in planning and services, and too large for administrative effectiveness. He produced a further Green Paper, which addressed some of the criticisms of the earlier scheme through a return to a regional element of organisation. There would be 90 local health authorities independent of local government, reporting to the DHSS through Regional Health Councils. The geographic areas covered by the local health authorities would correspond with those of local government, which would continue to be responsible for public health.

National Health Service Reorganisation Act July 1973

The Conservatives won the election in June 1970, and Sir Keith Joseph replaced Richard Crossman. Joseph produced his own proposals for NHS reorganisation that were embodied in a White Paper published in August 1972. Joseph retained the regional tier in the NHS which, it was hoped, would produce gains through integrated planning and management of capital projects. As in Crossman's plan, local health authority areas were to be matched with local government boundaries. Hospitals, nursing services, health centres and general practitioners were brought under the control of the new local authorities. These measures were incorporated in the National Health Service Reorganisation Act of July 1973. The tripartite structure of the NHS was thus replaced with a unitary structure based on Area Health Authorities (AHAs) reporting to Regional Health Authorities.

Labour returned to government in February 1974, and had little choice but to implement the planned reorganisation. Barbara Castle, Secretary of State for Social Services, was critical of centrally directed appointments to the AHAs. In a policy document entitled 'Democracy in the National Health Service', she outlined plans for widening popular participation in AHAs through local government.