(THIS DOCUMENT IS THE PROPERTY OP HER BRITAMIC MAJESTY'S GOVERNMENT)
COPY NO.
CABINET
REORGANISATION OF THE NATIONAL HEALTH SERVICE
Memo random. Jry the^ Chlef^S ecr e^taj
Treasu:
The S e c r e t a r y of State f o r S o c i a l S e r v i c e s proposes i n C ( 7 0 )
8
that we should decide f i r m l y and announce now that control of the
Health Service
should not be t r a n s f e r r e d t o l o c a l government.
agree that such a t r a n s f e r
at l e a s t .
i s not f e a s i b l e
i n the immediate
I
future
The c o r o l l a r y i s that we, the c e n t r a l Government,
will
continue to be r e s p o n s i b l e f o r f i n d i n g by f a r the g r e a t e s t part
of
the finance, and t o be f u l l y answerable to Parliament and the
e l e c t o r a t e , f o r the administration of the S e r v i c e at a l l
levels.
We cannot s h i f t t h i s r e s p o n s i b i l i t y p a r t l y on t o someone e l s e ,
however much we might wish to do so;
and t h i s i s why I d i s a g r e e with
one of the main aims of the N a t i o n a l Health Service
(NHS;
reorganisation
as proposed by the S o c i a l Services Secretary - namely, g i v i n g t o
interests a b i g g e r share of the r e s p o n s i b i l i t y f o r running the
2,
local
Service,
I b e l i e v e moreover that the way i n which the S o c i a l S e r v i c e s
Secretary proposes to t r a n s l a t e t h i s aim i n t o p r a c t i c e , v i a area boards
with a membership of as many as 20-22 composed as to about
of delegates of s p e c i a l i n t e r e s t s , would r e s u l t
two-thirds
i n confusion of the
lines of r e s p o n s i b i l i t y and encouragement of pressure blocks
the administration, t o the detriment of r a t i o n a l p r i o r i t i e s
efficient
3.
within
and
management.
I c e r t a i n l y agree that i t w i l l be important to secure
close
co-operation between the Health Service and l o c a l government, and that
a necessary and v a l u a b l e c o n t r i b u t i o n to Health Service management
should be provided by doctors and other members of the h e a l t h
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nrofessions.
But i t does not f o l l o w from this that d e l e g a t e s of
authorities and the h e a l t h professions
local
should constitute o n e - t h i r d each
of the membership of M S management, that almost a h a l f
of that membership
should be drawn from the medical and other p r o f e s s i o n s ,
and that members
appointed b y the S e c r e t a r y of S t a t e , with no s p e c i a l i n t e r e s t s ,
should be
i n a very small minority.
4,
The task of running the M S i n the f i e l d i s a formidable
one,
involving as i t does the disbursement of over 5 per cent of the N a t i o n a l
Income on a complex set of a c t i v i t i e s w i t h an unceasing problem of
priorities
i n matching demands w i t h a v a i l a b l e r e s o u r c e s .
I
therefore
welcome the developments envisaged by the S o c i a l Services Secretary t o
bring the c e n t r a l Department into c l o s e r contact with the management
the f i e l d ;
t h i s i s very d e s i r a b l e ,
i r r e s p e c t i v e of other changes,
in
in
order to give g r e a t e r assurance that n a t i o n a l p r i o r i t i e s w i l l be brought
to bear l o c a l l y .
But there w i l l always remain an immense task for the
operational management in determining r e l a t i v e l o c a l p r i o r i t i e s
and i n
securing the best value f o r the expenditure entrusted to the management
by u s , on the t a x p a y e r ' s b e h a l f .
does the Health S e r v i c e s u f f e r ,
I f mistakes are made;, then not
but resources are pre-empted which might
b e t t e r have been used f o r other s e r v i c e s .
management should, i f
only
The p r i n c i p l e s of
accountable
anywhere i n the public s e r v i c e , be brought p r e ­
eminently to bear i n t h i s area;
but the f i r s t
principle
of
accountable
management i s to ensure that operational control i s devolved, through a
c l e a r chain of r e s p o n s i b i l i t y ,
to persons chosen f o r t h e i r a b i l i t y
for
the t a s k .
5.
I conclude t h a t the bodies entrusted with the management of the M S
ought to be as small i n s i z e as p o s s i b l e , with a view to encouraging a
sense of corporate r e s p o n s i b i l i t y ;
that to the g r e a t e s t extent
t h e i r members should be appointed by the S e c r e t a r i e s
minimise confusion over the l i n e s of r e s p o n s i b i l i t y ;
some s p e c i a l i n t e r e s t
cent of the whole;
(e.g.
of S t a t e ,
possible
so a s to
that members with
d o c t o r s ) should not t o t a l more than 2 5 per
and that i f we are to make p r o v i s i o n f o r
delegates
of p a r t i c u l a r o r g a n i s a t i o n s , then ( a s has p r e v i o u s l y been accepted by
Ministers c o l l e c t i v e l y )
the number of such delegates must t o t a l l e s s than
a majority.
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6.
I t may be that we should be w i s e , i n any event, t o avoid
spelling
out in the r e v i s e d Green Paper on NHS r e o r g a n i s a t i o n a p r e c i s e
s p e c i f i c a t i o n for the composition of the managing a u t h o r i t i e s .
so might encourage the l o c a l a u t h o r i t y a s s o c i a t i o n s and the
To do
British
Medical A s s o c i a t i o n to r e g a r d our s p e c i f i c a t i o n as a base from which t o
press for more.
But I consider i t
e s s e n t i a l that the r e v i s e d G-reen
Paper should s t a t e f i r m l y the p r i n c i p l e that composition and methods of
appointment should be geared to the f a c t
of continuing c e n t r a l Government
r e s p o n s i b i l i t y and the need f o r as objective and e f f e c t i v e
as p o s s i b l e .
J.D.
Treasury Chambers,
SJI.1,
13th. January 1970
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management