Health Services Act 1980

Patients First

The 'Patients First' consultation document was published in December 1979. It largely agreed with 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.

Health Services Act receives royal assent

The outcome of the 'Patients First' consultation was the Health Services Act 1980, which received royal assent in August 1980 and provided for structural reorganisation of the NHS in 1982. The Act 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.

In effect, the DHAs would replace the area health authorities and their district management teams. Sharing the same boundaries as local authorities was no longer preferred and DHAs resembled the old single-district areas and comprised natural communities. There was a widely held view that the NHS reorganisation for the 1970s had produced too many tiers.

The changes as a result of the Act removed the area health authority layer. The planning system was made more flexible, which was essential during an economically difficult period. Regional health authorities (RHAs) were expected to 'stand back' from the activities of the DHAs, but would continue to retain monitoring and implementing district plans and financial control.

However, the government rejected the Royal Commission's proposal that RHAs should be directly accountable to parliament, arguing that the secretary of state should retain that accountability.