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Milburn proposes to decentralise the NHS

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7294.1083 (Published 05 May 2001) Cite this as: BMJ 2001;322:1083
  1. Jacqui Wise
  1. London

    The number of health authorities in England will be cut from 99 to 30 as part of a radical reorganisation of the NHS.

    Launching the NHS Modernisation Agency, the health secretary, Alan Milburn, said that the new plans would give more power to frontline staff and release £100m ($140m) for patient care.

    By 2004, two thirds of the 99 health authorities will have merged, with many of their responsibilities devolved to primary care trusts. The 30 remaining “strategic health authorities” will monitor the performance of local health services and provide a link with the Department of Health. Each will cover an average population of 1.5 million, broadly corresponding to the emerging clinical networks, such as for cancer services.

    Primary care trusts will be responsible for identifying and commissioning the health services needed by local people. By 2004 they will be responsible for allocating 75% of the NHS budget of £57bn. They will be accountable to the new health authorities but will have greater operational freedom than they currently do.

    Mr Milburn said: “This new flatter structure will help liberate local services so that they can get on with the business of reform. It will also free over £100m from bureaucracy for investment in frontline services.”

    The NHS Confederation, which represents NHS trusts, primary care trusts, and health authorities, broadly welcomed the move. Its chief executive, Stephen Thornton, said that the reduction in the number of health authorities was a sensible and logical step to take and that health authorities were already taking on some of the key roles of the strategic health authorities.

    But he warned: “The money saved from reducing the number of health authorities needs to be ploughed back into supporting doctors, nurses, and managers in primary care trusts.”

    The BMA's chairman, Dr Ian Bogle, said: “The awareness of what is required for patients rests at local level, and the people who are delivering and receiving health care in an area are the ones who are likely to know where local investment should be made.

    “But anything that involves taking doctors away from their patients is going to increase the workforce and workload problems that are already there. Local decision making will only work if generous resources are provided locally to allow that process to happen.”

    A spokesperson for the King's Fund, an independent healthcare charity based in London, said: “It is easy to re-jig structures, but too much reorganisation can be very disruptive. For the new system to work there needs to be a lot of support on the ground and a hands off attitude from Whitehall.”


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