National Health Service (Structure and Management) (Hansard, 17 June 1981)

§ Mr. Nicholas Edwards

Following extensive consultations during which I have had the benefit of advice from many sources, including the Welsh Grand Committee, I have concluded that my policy for more efficent, economical and local management is best served by the retention of the existing area health authorities, with the exception of Dyfed AHA. In the consultation document I attached great importance to the principle that decision-making should, as far as possible, be delegated to the point at which patient services are dispensed through the creation of a new system of unit management. I am glad to say that this concept has been widely welcomed, and although the AHAs will continue to act as my agents in the planning and management of the health services in their areas, there will be maximum decentralisation consistent with their overall responsibilities for policies, priorities and resources allocations.

I have accepted the units recommended by authorities, following their local consultations. In the seven authorities, apart from Dyfed, this will result in the introduction of 36 units and the replacement of health districts where they exist. The target date for bringing the new arrangements into operation is 1 April 1982. Achievement of this date will depend on progress of negotiations in the Whitley councils as well as on the progress of health authorities' preparatory work.

I am determined that more local decision making will become a reality in the NHS in Wales and that there should be no move towards increased centralisation within area health authorities. Therefore my Department will be issuing management guidance which though it will allow authorities sufficient flexibility to introduce arrangements most appropriate to their local circumstances, will be firm on the need to delegate finance and manpower budgets to units. Authorities will be required to submit to the Department for approval management plans clearly demonstrating the delegation of responsibilties to the local level and approval will not be given to plans that introduce an intermediate tier of management between the area administration and those at unit level. There will be key roles for unit administrations, directors of nursing services and representatives of the medical profession at unit level. I shall be issuing guidance soon on the medical professional input. As managers settle in at unit level they may be able to suggest adjustments in responsibilities vis-à-vis those at area level and authorities will be expected to review this after a year's experience of the working of units.

I turn now to the special problem of Dyfed. The arrangements in the area at present managed by the Dyfed 382W AHA have been very widely criticised. Indeed, the response in the consultations concerning this authority has been unique in recording a majority in favour of splitting the authority rather than trying to improve management through the introduction of local units. I have considered very fully the several options for more satisfactory management in Dyfed that have been put to me, including the proposal for a West Dyfed health authority, put forward by the hon. Member for Cardigan (Mr. Howells) on behalf of certain representative bodies in his constituency.

However, I have concluded that improvements in this area are best achieved by dividing Dyfed AHA into a health authority covering the old county of Pembrokeshire and an authority encompassing the present Ceredigion, Carmarthen-Dinefwr and Llanelli-Dinefwr health districts, and I shall be seeking parliamentary approval for this in due course. The West Dyfed authority would almost certainly have involved settin up an entirely new area organisation geographically located somewhere between the two principal hospitals, in order to link two districts that have relatively little in common. The additional cost and bureaucracy would not be justified in terms of any likely benefits.

The smaller AHA I have decided on will meet the virtually unanimous demands in Pembrokeshire for an authority responsive to local needs. It should be possible to create a simplified management structure in this relatively compact area centred on a single major hospital, though the new authority will be free to consider its own unit structure. I propose asking the new authority to meet similar management cost targets to those I shall be seeking elsewhere; and I am confident that those who have pressed so hard for a separate authority can and will establish an organisation that is not just a repetition of that existing in much bigger AHAs, but is one that is tailor-made for the particular situation.

I do not accept the argument that such an authority will not be strong enough to play its part in all-Wales planning or to present its case effectively for the resources it will need. In the larger authority I shall require the delegation of important responsibilities to the Ceredigion and Llanelli areas and a greater degree of decentralisation than is likely under the arrangements proposed by the existing Dyfed AHA in the papers they have submitted to me.

The onus will be upon these two authorities to make the new arrangements work efficiently and economically, and I shall expect them to co-operate closely to avoid unnecessary duplication. The introduction of these new authorities need not affect the existing flow of patients in Dyfed and I see no advantage in departing from the existing district boundaries. The unique problems of Dyfed call for a unique solution.

The interests of staff affected by the structure and management changes will be protected as in the rest of the United Kingdom. However, the proportion of the NHS budget devoted to management will not be allowed to rise as a result of the reorganisation; indeed, the NHS in Wales will be required over a period to reduce the proportion by one seventh from the 1980 level of 5.24 per cent. to 4.5 per cent.

At the all-Wales level I have decided that there is justification neither for a regional health authority, which had some support in the consultations, nor for a Welsh health council. Although the latter also attracted support, it seemed destined to be an unwieldy body, given the very 383W large number of requests to be represented on it. I have concluded that the weakness identified in present arrangements for ensuring that region-wide issues of health policy and management receive a sufficient public airing will be best remedied by the introduction of a series of formal meetings under my chairmanship or that of my hon. Friend, the Member for Conway (Mr. Roberts).

The meetings will involve AHA chairmen and representatives of the major professions or local authorities with an interest in or contribution to make to particular subjects on the agenda. The membership would vary depending on the issues under discussion and the main papers would be available to the Select Committee on Welsh Affairs. In that way, and by keeping the media informed, there should be greater public awareness and understanding of issues at the all-Wales level.

I have previously made it clear that community health councils will continue, and I am currently considering their role and membership following a separate consultation exercise. I shall also be giving attention to the relationship between family practitioner committees and area health authorities in the light of my decisions on structure and management and of the consultation on FPCs taking place in England.