LEGISLATION

AuthorJohn Finch
DOIhttp://doi.org/10.1111/j.1468-2230.1981.tb01624.x
Publication Date01 Jan 1981
LEGISLATION
REORGANISING THE NATIONAL
HEALTH
SERVICE
REORGANISATION in the National Health Service has for the last few
years become something of a dirty word. Dirty to the administrators’
because no sooner have they settled down from the major reshuffle
following the
1973
reorganisation Act than another, and very
different, reorganisation is upon them; and dirty from the politicians’
viewpoint
if
they are not in office, and those who are in office want
to
knock down the earlier dogmas and substitute different ideologies,
because that is
eo
ips0 dirty. The Health Services Act
1980
provides
a large dose of both varieties. Its two principal claims to attention
are
(1)
the commencement of plans to remove the area administrative
tier, and
(2)
the removal
of
earlier legislative restrictions on the
private use of National Health Service faci1ities.l
Reorganisat
ion
The report of the Royal Commission
on
the National Health
Service provided the first comprehensive review of the NHS since
the Guillebaud Committee reported in
1956.
The Commissioners
received much evidence critical of the
NHS,
but concluded that
we
need not feel ashamed of our health service and there are many
aspects of it
of
which we can be justly proud.” The Government,
while accepting this assessment, believes that the Service can be
improved by changes which will make it more responsive to patient
needs and a better service to work for. The Royal Commission made
over
100
recommendations, covering a wide range of issues. As
Parliament was told when the report was published, the Commission’s
recommendations on many matters are being studied by the Health
Departments through the ordinary machinery.
The first objective of the
1974
reorganisation, the integration of
service, for patients in the hospital and in the community, has been
substantially achieved. But there has been widespread criticism of
the
1974
changes which the Royal Commission summed up as: too
many tiers; too many administrators, in all disciplines; failure to
take quick decisions; money wasted. The
1974
reorganisation was
a massive undertaking carried out to a tight timetable. The Royal
Commission judged that it produced,
an immense amount of administrative work in preparation
for the new machinery; disruption of ordinary work, both before
and after re-organisation caused by the need to prepare for and
implement the changes; the breakdown
of
well-established
formal and informal networks; the loss of experienced staff
-
~
1
The Act is a Great Britain measure, not extending to Northern Ireland,
so
some
of
its provisions are duplicated,
or
nearly
so,
in
order to amend the different
statutes regulating the English and Welsh health services
on
the
one
hand and the
Scottish
on
the other.
2
Cmnd.
7615,
published July
18,
1979.
68

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