Abstract
Local administration of health care has always been fragmented. Resistance to local authority control by the medical profession was partly responsible for the separation of the NHS from local government, and rivalries within the medical profession secured a privileged status for the hospital services; even within this, teaching hospitals retained a separate identity until 1974. Despite various reorganisations, this tripartite division largely persists, though the 1974 reorganisation sought some coterminosity between AHAs and local authorities, and introduced local authority nominations to health authorities. The question that remains to be answered is: what form of local administration would best secure the delivery of health care?
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Notes and References
Patrick Jenkin, HC Deb., v. 991, c. 67, 27 October 1980.
C. Ham,’ search for a vision’, Guardian, 19.1.94, p. 17.
One could draw a parallel with the establishment of several government departments (or units thereof) as ‘next steps’ agencies, in which ministers were accountable to parliament only for the results of these organisations’ activities, not for the ways in which they went about their business. Clearly such an approach had attractions for those Conservatives who believed that, in contrast with the time-honoured cliche, ministers should not have to be aware of every bedpan dropped in every hospital in the NHS.
Stan Orme, HC Deb., v. 991, c. 92, 27 October 1980.
HC Deb., v. 163, c. 507, 7 December 1989 — emphasis added.
Independent, 5 July 1993, p.7.
A succession of parliamentary questions during the summer of 1993 made public the available information about the background of appointees to NHS trusts and health authorities, while later figures showed that 60 per cent of all chairs of trusts in England, and 50 per cent of non-executive members, had a business or financial background, while only 4 per cent and 6 per cent respectively had any NHS background (HC Deb., v. 235, c. 1031, 20 January 1994).
See HC Deb., v. 224, c. 604-621, 10 May 1993, for opposition criticisms of this process. Note also the speech by Jack Straw, shadow environment spokesperson, to the Audit Commission on 5 March 1993, in which he criticised the much greater rewards available for health authority and trust chairs compared with those offered to council leaders, saying that ‘what offends against democracy is to offer greater incentives... to be selected to serve the unelected state... than to be elected to serve the local community’.
R. Cook, HC Deb., v.163, c. 519, 7 December 1989 — emphasis added.
‘Cuts may close hospital wards’, Guardian, 20 September 1983.
Brent refused to implement ‘horrendous’ service reductions in order to lose 100 jobs, and cut spending by £250000. ‘Brent’s resistance may crumble’, Guardian 11 October 1983;’ stockport joins health cuts revolt’, Guardian, 12 October 1983. The DHAs involved included Northumberland, Stockport, Sheffield, West Lambeth and Islington, while the Richmond, Twickenham and Roehampton DHA and the Wandsworth DHA both deferred decisions on implementing the required reductions.
‘Rebel health authority defies cuts threat’, Guardian, 18 October 1983.
‘Brent health rebels receive sacking threat’, Guardian, 22 October 1983.
As of December 1984 — HC Deb., v. 70, c. 686-94.
Guardian, 23 March 1984.
Guardian, 9 September 1983.
Quoted in the Newcastle Journal, 4 May 1984, p. 1.
This is documented by the regular bulletins of London Health Emergency; see also London Health Emergency (1987b), and PSPRU, 1992.
Social Services Committee, 1990f, p. ix.
HC Deb., v. 175, c. 404, 27 June 1990.
HC Deb., v. 220, c. 401-4, 3 March 1993.
Alan Milburn, HC Deb., v. 220, c. 416, 3 March 1993.
Social Services Committee, 1990c, p. xvii.
K. Clarke, HC Deb., v. 163, c. 512, 7 December 1989.
Evidence to the Health Committee, 1991c, Q158.
Ibid., Q167.
HSJ, vol. 102, no. 5392 (27 August 1992).
HSJ, vol. 102, no. 5287 (30 January 1992) p. 3.
‘Bottomley signals fresh NHS changes’, Guardian, 27 June 1992, p. 4.
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© 1995 John Mohan
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Mohan, J. (1995). Powers, Responsibilities and Accountability: Organisational Reform and Local Autonomy. In: A National Health Service?. Palgrave, London. https://doi.org/10.1007/978-1-349-23897-2_9
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