Volunteers Retained as Managers: N. H. S. Reorganization Changes Authority Members’Role
| Author | B. L. DONALD |
| DOI | http://doi.org/10.1111/j.1467-9299.1975.tb00223.x |
| Published date | 01 September 1975 |
| Date | 01 September 1975 |
Volunteers Retained as Managers
:
N.
H.S.
Reorganization Changes Authority
Members’ Role
B.L.DONALD
Mr.Donald
is
a Senior Lecturer associated with Health Service Management
Programmes
in
the Department
of
Social Administration, University
of
Manchester.
With the synchronized reorganizations
of
local government and health care
of April
1974,
public administration in the
U.K.
has undergone considerable
change. Among the people challenged, and perhaps perplexed, by the
changes are present and former members of authorities managing the
national health service (see diagrams
I
and
2).
The changes affecting them
mark
a
further stage in the evolution in British society of a series
of
unpaid,
official and unofficial roles concerned with the care of the sick. From
1603
this series has included the overseers of the poor appointed and supervized
by magistrates, elected guardians of the poor, nominated and self-appointed
governors of medical charities and hospitals. In this century it has included
members of Local Insurance Committees concerned with general practi-
tioner medicaI care for manual workers under social insurance, and of the
public assistance and health committees of local authorities which inherited
and began forty years ago to transform public hospital provision for the
sick poor. Now it includes members of both the old and new
NHS
authorities.
This series
of
offices involves an interesting alternation between
‘representative election’ and ‘appointment by nomination’ or between
what has been typified as the ‘elected representative’ and ‘lay gent’,l
qualified to match the professionals in managing institutions but unwilling
to face political elections. Although the earliest roles in the series antedated
universal suffrage, most of these offices, whether established by election or
appointment, have combined elements
of
management and representation.
In
1974
an attempt was made to change this tradition with the separation
of management and representative functions in health care between
different bodies, the Area Health Authority and the Community Health
Council.
The interest
of
the latest arrangement
is
not just historic. It is part of the
attempt to find an appropriate balance in health care between
:
299
PUBLIC ADMINISTRATION
(I)
localization and centralization of decision making; and between
(2)
authority based on community representation and authority based
These are important factors in the international comparison
of
health care
systems and the new arrangements merit an initial assessment of their
effectiveness although, as the reorganization is only a year old, we must
rely on the manifest intentions of government policy rather than study of
organizational behaviour. Some selective and speculative comment will be
possible based on an association with a series of university based seminars
for new authority members held in late 1973 and early 1974. Additionally,
it will be possible to comment on recent events which include the 1974
Labour Government’s proposals to modify some aspects of the changes.2
on managerial expertise.
NEW HEALTH AUTHORITIES
There are ninety area authorities and fourteen regional authorities in
England. Area authorities are not only more numerous but, in terms
of
collaboration with local government and accountability for operational
management, changes in their membership and its style are more signifi-
cant. Generally, we will be discussing Area Health Authorities.
An Area Health Authority
(AHA)
comprises
:
(I)
a part-time paid chairman, appointed by the Secretary of State;
(2)
part-time voluntary members appointed by the Regional Health
Authority after consultation with:
(a) bodies representative of five named professions, doctors,
dentists, nurses and midwives, pharmacists and opticians
;
(b) bodies considered representative of interests in health care;
(c) in the first instance, existing health authorities and thereafter
the
AHA
itself;
(3)
members appointed by the
RHA
after consultation with universities
associated with health services,
(4) not less than four members appointed directly by the local
authorities to whose area the territory of the
AHA
has been
matched; and
(5)
in the case only of an
AHA
with a university teaching hospital in
its purview, members with experience
of
the management of a
medical teaching hospital. Such authorities will be known as
AHA
(Teaching)S.
A Regional Health Authority
(RHA)
is appointed in England by the
Secretary of State and is constituted after similar consultations.
Appointments are normally to be for four years and initially they have
been arranged
so
that half the membership will be due to retire every two
years. The composition of the membership is in many ways similar to that
of the former hospital and family practitioner service authorities; a mixture
of professional, local authority and relevant voluntary organization
300
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