The reorganisation of the National Health Service, 1965-74.

Brewer, Robert Charles (1980). The reorganisation of the National Health Service, 1965-74. MPhil thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000fcaa

Abstract

This is a case study of the development of plans for an administrative reorganisation and the part played in that process by interest groups and government departments. It is argued that changes in the context in which the NHS operated in terms of demography, epidemiology, social philosophy and administrative concepts as well as problems of cost and co-ordination had made adjustments to its structure desirable, and that proposed changes in the structure of local government and its social services crystallised this need. The reparation of medical and social work skills in the field by the implementation of the Geebohm Report made a fundamental review of the NHS structure necessary as it involved a shift in cost burdens from local to central government which invited questions concerning administrative supervision from the centre and political questions concerning the future of the medical officers of health.

It is argued that the reorganisation involved questions of both vertical control and lateral co-ordination. The former was determined by the desire of the Treasury for a greater degree of management accountability and of the Central Department for improved control and implementation of policy decisions, which meant that few concessions were made to interest groups which might hinder the attainment of these objectives. Interest groups were more influential in determining the character of proposals concerned with lateral co-ordination, and here the pattern indicated by Willcocks in his study of the creation of the NHS is found to be repeated, with groups commanding resources based on technical expertise (the medical profession) found in varying degrees to be more influential than those commanding administrative expertise (local government).

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