The Patients First consultation document was published in December 1979 and largely agreed with the recommendations made by the Royal Commission on the National Health Service in July 1979, which was critical of the changes made to the NHS by the 1974 reforms, in particular problems associated with too many administrative tiers in the system.
The document set out changes to the structure and management of the NHS to enable a more responsive and efficient service. The government proposed to establish district health authorities serving areas similar to the old health districts. The area tier would be removed, although there were already a number of single-district areas which were in effect unchanged.
Regional health authorities would be responsible for establishing the new district health authorities. They were then expected to ‘stand back’ from the activities of the district health authorities, but would continue to retain monitoring and implementing district plans and financial control. The government rejected the Royal Commission’s proposal that regional health authorities should be directly accountable to parliament, arguing that the secretary of state should retain that accountability.