Robert Brewer

The Politics and Process of Reorganisation Robert Brewer

The tripartite structure of hospitals, general practitioners and local authority public health services which characterised the establishment of the National Health Service in England and Wales in 1948 tended to be regarded as the best available compromise at the time and as probably temporary in nature. To a considerable extent, it represented the outcome of a tussle between the important interest groups involved, with the medical profession largely emerging triumphant, local government retaining relatively low status public health services, and the voluntary hospitals losing everything. This research which is presented here, was undertaken almost contemporaneously with the events described, examines the process through which the first reorganisation of the National Health Service in England and Wales was undertaken between 1965 and 1974, viewed through the eyes of the principal players - the Ministry of Health/Department of Health and Social Security, the Treasury, the various branches of the medical profession and the local government bodies. The process is placed in the context of various ideas concerning the delivery of health and social care services and management in public administration which had emerged since 1948, together with the potential impact of local government reform which was then under consideration. The shifting balance between the demands of central vertical control for reasons of budgetary and policy control against the need for horizontal integration to meet more effectively the needs of patients is reviewed, and an assessment made of the gains and losses of the various interests involved.