'The administrative structure of the medical and related services in England and Wales' green paper

Administrative reform of the NHS

The green paper National Health Service: the administrative structure of the medical and related services in England and Wales was published in July 1968. The plans outlined in the paper were described as ‘tentative’. The paper stated that it was important for central government to set the strategic direction for the health system and allocate resources, but its role in direct management should be limited.

Area authorities

The paper focused on administrative reform of the NHS and proposed the creation of up to 50 authorities in local areas (to be known as area authorities), which would be directly responsible to the minister of health.

These new area authorities would replace executive councils, regional hospital boards, boards of governors and the 400 hospital management committees. Their main role would be to make policy decisions, secure funding and manage resources. They would also be responsible for developing mechanisms for the integration of separate services.

Area authorities would:

• coordinate a comprehensive system by keeping an overview of local services
• provide a single tier for managing hospitals in the hope that that this would end the division between day-to-day control and major planning.

The paper discussed the possibility of area authorities taking over community health services, noting that a comprehensive health system that was unified in structure (combining hospital services, general medical services and local authority provided services) would particularly benefit those with long-term conditions.

Area authorities would be able to enter into contracts with medical, dental and pharmaceutical providers. This arrangement was hoped to get general practitioners and family doctors to be more involved in the health service as a whole, as well as ensuring better coordination between all branches of the health service.