District health authorities (DHAs)

Structural reform

The Health Services Act 1980 enabled the Secretary of State for Social Services to establish district health authorities (DHAs) and specified that regional areas did not need to be based around area health authorities (AHAs). In effect, the DHAs replaced the area health authorities and their district management teams.

The aim of the reform was to simplify structures by abolishing the AHA tier. The National Health Service (constitution of district health authorities) order came into force on 1 April 1982 and created 192 district health authorities (DHAs) to replace the 90 area health authorities (AHAs) in England.

The intention was that, as smaller organisations, the DHAs would be closer to local populations and therefore be in a better position to identify local needs. DHAs would assess local health needs, employ staff and plan and administer hospital and community services, under the guidance of the regional health authorities (RHAs), whose responsibilities were unchanged.

Sceptical response

The structural changes meant that the alignment between health and local authorities was affected. Scepticism about further reform was expressed and a parliamentary debate was held on 18 February 1982 following a motion to annul the order.

Backbench MP, Nicholas Winterton, referenced the circularity of reform (although his comments could be seen as somewhat unfair given the complexity of the structures in place before the reforms):

'We were advised by a previous Conservative Government, who reorganised the NHS, that they would make it more efficient so that it would cost less. They said the same about local government. We know that both statements were untrue. Not only has the NHS become more inefficient; it costs a lot more as well.'