The Secretary of State for Health and Social Security, Richard Crossman, Kenneth Robinson’s successor, produced a second green paper, The future structure of the National Health Service in England, on structural reform of the NHS, following the publication of The administrative structure of the medical and related services in England and Wales in 1968. There had been strident criticism of the first green paper and Crossman’s paper fared no better. The paper was criticised for increasing centralised control of the NHS, which was said to present ‘a threat of central control which could hamper the development of British medicine and is not acceptable as the pattern of health administration for years to come’.
The government had three firm assumptions about the future administrative structures, namely:
- local government would not administer the NHS: area health authorities (AHAs) would run the NHS, reporting directly to the secretary of state
- the administrative boundaries between the NHS and local authorities (providing public health and personal social services) had to be made clearer, and
- the number of new AHAs must match the number of local authorities (the new counties and county boroughs).
The paper highlighted feedback in response to the green paper The administrative structure of the medical and related services in England and Wales (1968). Integration was a common theme that received support. However, there were recurring concerns that the 50 area authorities (AAs) proposed in the 1968 green paper would be too distant from local populations and would be too dominated by hospital services. Instead of creating 50 AAs, the government proposed establishing 90 AHAs to match the number of local authorities. The government also intended to establish 14 or more regional health councils, which would be responsible for the overall planning of hospitals and organising facilities for medical and dental education and training.
The paper rejected the idea of unifying responsibility for the NHS under local authorities. However, it concluded that the new AHAs should be co-terminous with local authority areas providing social services. AHAs would be responsible for services where the principal skill required was that of health or medical professionals, and local authorities would provide services where the main skill was social care and support. Seeing the need for the health and social services to work together and believing that the task was too big for a single organisation to do both, the government wished to see co-terminosity between health and social care professionals.
AHAs would be responsible for planning services with allocated budgets and would be responsible for promoting and facilitating integrated health services.
Doctors, dentists, opticians and pharmacists would enter into contracts with family practitioner services (FPSs) (as they had with executive councils). AHAs would have a statutory obligation to establish FPSs and AHAs would be expected to coordinate with FPSs and other services when planning local services.
The secretary of state would also establish a new Central Advisory Council to advise on health service matters, including resource allocations.