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Your NHS Monday, 20 September, 1999, 17:38 GMT 18:38 UK
The changing role of health authorities
The role and influence of the 100 district health authorities in England is being changed radically by the government.

Prior to the controversial reforms implemented by the Thatcher government in 1990, district health authorities were responsible for both the finances and the provision of services in the NHS.

However, the 1990 reforms created an internal market in the health service. Health authorities retained control of the NHS finances, but were now charged with purchasing services from individual hospitals, which controversially were set in competition which each other for health authority business.

In addition, some individual GPs, known as fundholders, were given budgets with which they were able to buy services from hospitals without having to consult their local health authorities.

District health authorities worked alongside family health services authorities, which were responsible for managing primary care services such as general practice, pharmacy and dentistry. However, the two were merged in April 1996 to create the current structure of 100 district health authorities with a combined role.

Internal market

Initially, Labour was opposed to the internal market, but on attaining office decided to keep the split between purchasers and providers. Fundholding, however, is to be scrapped from April next year. Instead groups of GPs will take collective responsibility for purchasing services locally from hospital providers.

The collectives, to be known as primary care groups, will also have input from other health professionals such as nurses, and from social services experts. There will be approximately 6-8 primary care groups in each district health authority area.

There will be different types of primary care groups. At the lowest level, the groups will simply advise the district health authority on the best way to purchase services. However the government is keen that eventually all primary care groups will take direct responsibility for all purchasing decisions, setting themselves up as free standing independent organisations.

Changing role

When this happens the purchasing role of the district health authorities will be effectively ended. Instead, health authorities will develop a monitoring role. They will be responsible for assessing local health needs and for developing three-year Health Improvement Plans to make sure those needs are met.

The Health Improvement Plans will be drawn up in partnership with NHS trusts, primary care groups, social services and other agencies. Health authorities will also decide on the range and location of health care service based on agreed strategic plans.

However, a clear indication of the reduced role health authorities will play is given by the fact the government intends to reduce their number. Those remaining will be overseen by eight regional offices of the NHS Executive, the body charged with implementing government policy and distributing NHS funds.

In Scotland, the Scottish Office Department of Health is responsible for health policy and administration. Instead of district health authorities, there are 15 Health Boards. There is no regional management tier. GPs in Scotland will be able to set up primary trusts, but unlike their English counterparts, they will be directly responsible to the Health Boards for purchasing decisions.

Overall control for the health service in Wales rests with the Welsh Office Health Department, which is split into five divisions. There is a system of single tier health authorities responsible to the Health Financial Management Division.

Different structures

In Northern Ireland, overall responsibility for the health service rests with the Department of Health and Social Services (DHSS). Within this department the Health and Social Policy Group (HSPG) sets overall strategy for health and personal social policies.

The Health and Social Services Executive (HSSE) is responsible for securing efficient delivery of health and personal social services in Northern Ireland.

Four Health and Social Services Boards - Northern, Southern, Eastern and Western - are responsible for commissioning the delivery of health and personal social services.

This is an integrated approach, combining health and social services, which differs from the rest of the United Kingdom

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