Two green papers on structural reform of the NHS

Administrative structure of the medical and related services in England and Wales

Minister of Health Kenneth Robinson's green paper Administrative Structure of the Medical and Related Services in England and Wales was published in July 1968. The green paper stated that, while it was important for central government to set the strategic direction for the health system and to allocate resources, it should not be involved in the direct management of the NHS.

Area authorities

The green paper proposed the creation of up to 50 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.

Area authorities would be able to:

• enter contracts with medical, dental and pharmaceutical providers
• co-ordinate a comprehensive system, by keeping an overview of local services
• provide a single tier for managing hospitals.

The paper reflected 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.

Future structure of the National Health Service in England

In 1970, the Secretary of State for Health and Social Services, Richard Crossman (Kenneth Robinson's successor), published a 'second' green paper. There had been strident criticism of the first green paper.

Crossman's paper, The future structure of the National Health Service in England, on structural reform of the NHS, fared no better. 

The government had three firm conclusions:

• local government would not administer the NHS. Area health authorities would run the NHS, reporting directly to the secretary of state
• administrative boundaries between the NHS and local authorities providing public health and personal social services must be clear
• the number of new health authorities must match the number of local authorities (the new counties and county boroughs).

Area Health Authorities

Specifically, the government proposed establishing 90 area health authorities (AHAs) and at least 14 regional health councils, which would be responsible for organising medical and dental education, as well as taking responsibility for the overall planning of hospitals.

AHAs would have a statutory obligation to establish family practitioner services (FPSs), which would contract with doctors, dentists, opticians and pharmacists.

AHAs would be responsible for services where the principal skill required was health related. Local authorities would provide services linked to care and support skills. Seeing the need for the health and social services to work together, and believing that the task was too big for a single organisation to do both, the government wished to see co-terminosity between health and social care professionals.

The secretary of state would also establish a new Central Advisory Council to advise on health service matters, including resource allocation.

Response

The paper was criticised for increasing centralised control of the NHS, which was said to present 'a threat of central control which could hamper the development of British medicine and is not acceptable as the pattern of health administration for years to come'.