'National Health Service reorganisation' white paper

A change of government and a change of secretary of state led to the white paper on National Health Service reorganisation. This outlined significant structural and administrative reform of the health system.

Following the publication of the Seebohm report in 1969, there had been much discussion of the boundary between social and health services and the effect this might have on the organisation of the NHS.

Integration of health and care services

The white paper proposed replacing the existing tripartite system covering family practitioner services, hospital services and personal health services (administered by local authorities) with a unified system of administration.

Although the paper rejected the idea of local government taking over the planning and delivery of all health services as a means to achieving true integration with social services, it emphasised the need for health services to coordinate and plan services in parallel.

Integration between the NHS and social care was a central aim in the paper. In the foreword it was frankly acknowledged that:

‘There is a need for far more ... services that support people outside hospital. Often what there is could achieve more if it were better co-ordinated with other services in and out of hospital’.

Structural changes

The paper proposed the creation of area health authorities (AHAs), which would be aligned with local authority areas. These bodies would be responsible for the planning and delivery of health services in consultation with the corresponding local authorities and regional health authorities (RHAs).

In practice, the day-to-day operation of services would be based around a population size or district of around 200,000 to 500,000 and would generally be linked to a district general hospital.

The Department of Health would make capital and revenue allocations to RHAs, which in turn would allocate money to the AHAs to meet the cost of local services. Payments to practitioners would be separately funded by the department.

It stated that health services and local authorities needed to coordinate their planning and delivery to ensure that the needs of individuals and groups were met holistically across health and social care services. The white paper acknowledged that:

‘a single family, or an individual, may... need many types of health and social care and those needs should be met in a coordinated manner’.

Transfer of public health to the NHS

The white paper proposed that public health or 'personal health services' previously provided by local government would continue to be a part of the NHS, but would instead be provided and managed by AHAs. The reforms would make family planning part of the NHS for the first time.

Personal health services included:

• vaccination and immunisation
• population health surveillance
• family planning
• health centres
• health visiting
• home nursing and midwifery
• maternity and child healthcare
• medical, nursing and other arrangements for the prevention of illness, care and aftercare
• ambulance services.

Environmental health functions and some health education responsibilities remained with local government, while all the previous duties of the medical officers of health were transferred to the NHS. Under the reforms, new community medicine specialists would be responsible for assessing the needs of local health services and developing preventive health services.

The white paper also outlined plans for community health councils (CHCs), which were bodies to represent the views of consumers in each health authority. It was intended that CHCs would have powers to visit hospitals and other institutions as well as powers to secure information.

The white paper also outlined its plans to establish a health service commissioner to investigate complaints against NHS authorities where an individual was dissatisfied with the response from the health authority.

Legislation

The provisions in the white paper were legislated for in the National Health Service Reorganisation Act 1973 and came into effect in 1974.