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20-426: Between 1948 and 1968 NHS financial allocations were essentially based on sequential inflation uplifts. A Regional Health Authority or Teaching Hospital could argue for an increase. The richer parts of the country had better funding in 1948 than the more deprived areas and so the differences between the various regions widened over time. In 1976-1977 there was an almost 30% difference in the revenue allocation between

40-746: A paper on Democracy in the NHS in May that added local government representatives to the new RHAs and increased their proportion on each AHA to a third. A Royal Commission on the National Health Service was established in 1975 and published its report in July 1979. It heard complaints that the AHAs created under the 1973 Act added an extra and unnecessary tier of management. In 1982, the 90 AHAs were replaced by 192 district health authorities (DHAs) under

60-711: Is an act of the Parliament of the United Kingdom that reorganised the administration of the National Health Service in England and Wales. The 1995 Act followed the introduction of an internal market within the NHS under the National Health Service and Community Care Act 1990 . The 1995 Act abolished the regional health authorities (RHAs), district health authorities (DHAs) and family health services authorities (FHSAs) established under

80-791: The Health Services Act 1980 , but the RHAs remained. Under the 1980 Act, RHAs retained their responsibilities for monitoring and implementing district plans and financial control but were expected to 'stand back' from the activities of the DHAs. The Royal Commission had also proposed that RHAs should be directly accountable to parliament but this was rejected by the government and the secretary of state retained that accountability. On their creation in 1974, there were 14 RHAs, but they were reduced in number to 8 in 1994 before being abolished altogether in 1996 and replaced by eight regional offices of

100-771: The NHS Executive as a result of the Health Authorities Act 1995 . The delegation of authority to DevoManc on 1 April 2016 was hailed by the editor of the British Medical Journal as a possible regeneration of regional health authorities. The RHAs closely followed the areas of the previous regional hospital boards established in 1947, but in many cases they were renamed. The regions were re-organised into eight regional health authorities by order in 1994. Health Authorities Act 1995 The Health Authorities Act 1995 (c. 17)

120-717: The National Health Service Reorganisation Act 1973 and Health Services Act 1980 . The RHAs were replaced by eight regional offices of the NHS Executive , and the functions of the DHAs and FHSAs were effectively merged and taken up by new health authorities . These reforms lasted until the next major reorganisation of the NHS under the National Health Service Reform and Health Care Professions Act 2002 . The 2002 Act abolished HAs and transferred most of their responsibilities to primary care trusts . It also created

140-441: The National Health Service Reorganisation Act 1973 to replace regional hospital boards and to manage a lower tier of area health authorities (AHAs) in England. AHAs were created for Wales but not RHAs. Separate legislation was passed for Scotland. In 1996, the regional health authorities were abolished and replaced by eight regional offices of the NHS Executive as a result of the Health Authorities Act 1995 . In July 1968,

160-456: The Secretary of State for Social Services . Responsibility for public health was also taken from local authorities and given to the secretary of state, who also took on responsibility for school health. In effect, there was also a third lower administrative tier as the work of hospital management was done at district general hospital level. The incoming Labour government of 1974 published

180-463: The 14 regions, with the North West having the least and North-East Thames region the most per head of population. Richard Crossman developed a formula based on population, beds and cases but its fundamental problem was that the formula was partly based on utilisation and current resources. Since utilisation depends on availability of resources which were unequally distributed it could not rectify

200-479: The Minister of Health, Kenneth Robinson , published a green paper , Administrative structure of the medical and related services in England and Wales . It proposed creating about 50 single-tier area boards taking responsibility for all health functions in each local government area. It triggered years of debate about the relationship between the NHS, local authorities, and health and social care. In September 1968,

220-665: The National Health Service drew attention to the inequalities of funding. Expenditure on NHS services in Scotland was £127.10 per head of population, in the NW Thames region £122.38, in the West Midlands £91.52. The four Metropolitan Thames Regional Health Authorities and most of the London Teaching Hospitals were disadvantaged by, and unhappy about, the new formula. The simplicity and transparency of

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240-572: The attention of the Committee to the problems of resource allocation and encouraged them to consider possible research to rectify this unacceptable situation. They produced a proposal for a complicated randomised controlled trial of different funding formulae, but the Minister, David Owen , rejected it as interesting but politically impossible. Owen established the Resource Allocation Working Party (RAWP), to examine

260-455: The formula made it difficult for politicians to manipulate. The idea that mortality should be used to influence the distribution of health resources was questioned on the grounds that most health care is provided for people who do not die. The formula devised by the Resource Allocation Working Party survived until 1989 and did reduce the funding gap between the Northern regions and London. It

280-504: The idea that the number and areas of the proposed new health authorities should match those of the proposed new local authorities , but added regional health councils which could undertake those activities for which the local area boards were too small. Following the election of the Conservative government of 1970, the new Secretary of State, Keith Joseph , amended Crossman’s 1970 proposals. Under these plans published in July 1971,

300-504: The possibilities of a better funding formula. It came to the conclusion that Standardised Mortality Ratios were a reasonable indicator of regional variations in health care needs in the acute sector. The Report of the Working Party also emphasised the need to develop and apply positive preventive measures such as promoting changes in smoking habits and improving the environments in which people live and work. The Royal Commission on

320-582: The problem. When Barbara Castle was Secretary of State for Health in 1972, the problem of regional resource inequality was addressed again. Her Special Adviser Professor Brian Abel-Smith had a particular interest in this problem (on which he had already advised Crossman, whose Special Adviser he had been earlier). He chaired the Advisory Committee to the Social Medicine and Health Services Research Unit at St Thomas' Hospital . He drew

340-525: The separate ministries of health and of social care merged to form the Department of Health and Social Security . In 1970, Richard Crossman rewrote Robinson's 1968 proposals, publishing a second green paper. Crossman rejected local authorities managing the health service and instead proposed that area authorities should remain directly under the Department of Health and Social Security. He retained

360-463: The upper-tier regional health authorities would also be responsible for general planning and the allocation of resources to the lower-tier area health authorities, as well as the coordination and supervision of the latter’s activities. This two-tier health system was in keeping with the Conservative government's proposals for a two-tier system of local government. After years of debate, reform

380-788: Was made under the NHS Reorganisation Act 1973 which came into effect on 1 April 1974. This was the first time the service had been reorganised since it was established in 1948. It ended the 1948 tripartite system of separate provision of hospital services under regional hospital boards , hospital management committees and boards of governors; family practitioner services under executive councils; and community health services (including health visiting, maternity services, vaccination and ambulance services) under local authorities. These organisations were replaced by one unitary structure of 90 area health authorities (AHAs) answering to 14 regional health authorities (RHAs) and, ultimately, to

400-598: Was replaced by a more complex formula announced in the publication of Working for Patients in 1989, and there have since been further changes and debate, particularly about the relative weighting to be given to old age, which favours more prosperous Southern areas, and deprivation which favours poorer Northern areas. Barnett Formula Gatrell, A.C. (2002) Geographies of Health: an Introduction, Oxford: Blackwell. List of NHS Regional Health Authorities (before 1996) Regional health authorities (RHAs) were National Health Service (NHS) organisations set up in 1974 by

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