NHS Reorganisation Act 1973
A change of government and a change of secretary of state led to the white paper on National Health Service reorganisation being published in August 1972. Integration between the NHS and social care was a central aim in the paper.
A unified health system
The NHS Reorganisation Act 1973 received royal assent on 5 July 1973 and came into effect in 1974. The act gave effect to the reforms outlined in the white paper.
It represented significant structural and administrative reform of the health system and outlined plans to unify the existing tripartite health system (comprising family practitioner services, hospital services and community services, established by the NHS Act 1946) with a unitary, integrated system.
Previously, there had been separate administrative structures for:
- hospital services (administered by regional hospital boards, hospital management committees and boards of governors)
- family practitioner services (administered by executive councils)
- personal health services (administered by local authorities and including services such as health visiting, maternity services, vaccination and ambulance services).
The Act brought together the above functions into one unified structure of NHS administration and gave the Secretary of State for Health and Social Security responsibility for school health.
Regional health authorities (RHAs) and area health authorities (AHAs)
The Act abolished regional hospital boards and hospital management committees and, most but not all, teaching hospital boards of governors (those of the London postgraduate teaching hospitals were preserved).
They were replaced with regional health authorities (RHAs) and 90 area health authorities (AHAs), which were responsible for the planning and delivery of healthcare services.
Public health functions and community health services were removed from the remit of local authorities and given to the new health authorities. The environmental health element of public health work remained with local authorities.
Some AHAs were multi-district, some single district, and each district centred on a district general hospital. It was at district level that the work of hospital management was done, creating an additional administrative tier.
AHAs acted as a unifier in the tripartite NHS system and were matched with local government boundaries. The Act placed an obligation on health authorities and local authorities to cooperate with each other in their bid to 'to secure and advance the health and welfare of the people in England and Wales'.
Joint consultative committees were established to advise AHAs and local authorities on the performance of their duties under the 1973 Act.
Later, in 1982, AHAs were to be replaced by 192 district health authorities. The Health Authorities Act 1995 abolished RHAs and replaced them with regional NHS Executive Offices, which were part of the Department of Health.
Family practitioner committees (FPCs)
As part of the 1973 Act, AHAs were also required to set up family practitioner committees (FPCs) that would be responsible for general medical services (as well as dental, pharmaceutical and ophthalmic services).
Later, under the Health and Social Security Act 1984, FPCs became directly accountable to the Secretary of State for Health (rather than to area health authorities). FPCs were abolished in 1990 and replaced by family health services authorities.
Community health councils (CHCs)
The NHS Reorganisation Act 1973 also established community health councils (CHCs) for each AHA area. CHCs scrutinised the NHS by monitoring and reviewing its performance and provided advice to ministers.
They also had the ability to take up and pursue patient complaints about health services and speak up on behalf of patients. CHCs had a legal duty to represent the views of the public and be an advocate for patients. CHCs were abolished in 2003.
Health Service Ombudsman
The NHS Reorganisation Act 1973 also created the Health Service Ombudsman role. The post that was first established as the post of Parliamentary Ombudsman had been created by the 1967 Parliamentary Commissioner Act to investigate the actions of any government department of authority or anyone undertaking an action on behalf of a government department.
The Health Service Ombudsman role was to include investigation of NHS bodies. The ombudsman was given powers to investigate NHS bodies including AHAs and hospital management committees. The commissioner was given powers to investigate:
- an alleged failure in a service provided by a 'relevant' body
- an alleged failure of a relevant body to provide a service or other action taken by the relevant body where a complaint has been made in relation to a person sustaining an injustice
- hardship linked to maladministration.
The Health Service Commissioner (Amendment) Act 1996 broadened the role of the Health Service Ombudsman by empowering them to investigate NHS care and treatment, and the clinical judgement of health professionals. Now, the Parliamentary and Health Service Ombudsman (PSHO) combines both roles.
The PSHO is responsible for investigating complaints about poor or unfair services as a result of actions by:
- a government department
- a government body
- NHS in England.
National Health Service Reorganisation Act 1973: Chapter 32.
House of Commons Public Administration Select Committee.
Time for a People's Ombudsman Service.
Health policy in Britain.
London: Palgrave Macmillan; 2009.