A change of government and a change of secretary of state led to the white paper on National Health Service reorganisation, which 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.
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.
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.
Transfer of personal health services from local authorities to the NHS
The white paper proposed that 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. Those services included:
- ambulance services
- 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
- vaccination and immunisation.
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.
The provisions contained within the white paper were reflected in the NHS Reorganisation Act 1973.