The Health Authorities BillBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6992.1421 (Published 03 June 1995) Cite this as: BMJ 1995;310:1421
- John Gabbay
- Professor Wessex Institute of Public Health, University of Southampton, Southampton General Hospital, Southampton SO16 6YD
Great care will be needed to avoid exacerbating unresolved and destructive tensions
Behind the Health Authorities Bill (about to complete its parliamentary stages) seethes a mass of unresolved tensions. On the face of it, all the bill will do is streamline the upper echelons of management in the NHS. It follows a major review of the NHS in 1993,1 which recommended that to refine the internal market the NHS should replace the old regional tier with eight new regional offices of the central NHS Executive and should enable the formation of local commissioning agencies from merged district health authorities and family health services authorities.2
Yet these small readjustments in bureaucracy will highlight at least three substantial areas of contention that are already pulling the NHS in different directions. Firstly, what will be the balance of power between the central NHS headquarters and the front line? Secondly, who will hold sway in the local purchasing of health care—the health commissions or the fundholding general practitioners—and will it really be led as intended by primary care? Thirdly, how will the decisions be made—by the market, by political forces, or by scientific evidence?
These three sets of interrelated opposing tensions threaten to undermine what would otherwise be the next logical step in improving how the service is organised. Concerns about the bill have also centred on more detailed matters such as who will hold junior doctors' contracts as they rotate among trusts, how postgraduate and continuing medical education will be coordinated, whether regional directors …