The Royal Commission on the National Health Service, chaired by Sir Alec Merrison, was established under Labour in 1976 at a time of anxiety about the NHS, finance and pay beds to consider the best use and management of the financial and human resources in the NHS. It reported three years later to a Conservative administration. Later in 1979, the Secretary of State issued his own consultative document, Patients First.
Sir Alec noted that ‘The NHS is not suffering from a mortal disease susceptible only to heroic surgery’. However, the Commission criticised the Health Minister and his department for trying to hold accountability over the expenditure of such an expansive organisation. It was recommended that to avoid the clouding of accountability and responsibility for action and practice, the operational responsibility of the NHS should be placed with regional health authorities (RHAs). The Commission also felt that there were too many administrative layers in the system and recommended that the regions should retain planning functions but there should only be one tier below RHAs.