- [1970s]-1992 (Creation)
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In 1982 the NHS was restructured. The aims of the restructuring had been laid down in the 1979 consultative document Patients First. These were to simplify administration and slim down planning and professional consultative machinery, to bring more efficient and accountable management at local level, and to promote the more efficient use of resources, also taking into account and encouraging the independent sector.
One tier of NHS management, the area, was removed in 1982. Regional health authorities were retained and increasingly used for policy review procedures to increase accountability. The basic unit of health care provision became the district, with the creation of new district health authorities. The district health authority usually, but not always, had the same boundaries as the old health districts. Members of the district health authority served on a voluntary basis and there were usually about 16 members, four of which were nominated by local authorities within the district boundaries, and the remainder nominated by the regional health authority. Regional appointees included one hospital consultant, one GP, one nurse, midwife or health visitor and one representative from a university with a medical school.
The consensus team at district level was retained, and all services under the team were divided into units of management, each unit having an administrator, nursing officer and a medical representative. Other than these basic requirements, districts were allowed to be flexible in their management arrangements and their staff appointments, although the emphasis was on maximum delegation to units. Planning and professional consultancy machinery were simplified. District medical committees were no longer a statutory requirement. Joint consultative committees with local authorities were retained, although representation on these was adjusted because the health authorities no longer had boundaries which coincided with local authority boundaries. Community health councils were also retained but were made smaller, matching the new districts. Because ambulances needed to be administered on a wider scale, one of the new districts in a former area usually managed ambulances on behalf of the others. Supply was administered at regional level. Although family practitioner committees were retained as before, they became more independent and their brief now included the management and planning of family practitioner services and not merely the administration of contracts.
In 1982, the four former health districts in North Yorkshire all became district health authorities: York, Harrogate, Scarborough and Northallerton.
The structure of York Health Authority
York Health Authority initially included the same number of hospitals and services as it had formerly had as a district. An adjustment was made in 1983 when Whixley Hospital and Ripon Hostel were transferred to Harrogate Health Authority.
The chief officers of the authority were the district administrator, the district treasurer, the district nursing officer and the district medical officer. The officers oversaw the operational management of services while the members of the new authority reviewed and developed services. Each chief officer headed a functional hierarchy. Together, the chief officers formed the District Management Team which also included a general practitioner representative and a consultant representative. Much managerial and financial authority lay in the hands of the district management team. It was responsible for the allocation and control of resources and was the primary source of advice to the authority to which it was directly responsible.
For each unit of management in the district there was also a unit management team, to act as a co-ordinating body between administrative, medical and nursing staff within its given area of services. While individual administrative and nursing members of the unit team were in line to the district administrative officer and the district nursing officer respectively, the unit team jointly had responsibility as a co-ordinating body between administrative, nursing and medical staff. It also prepared budgets for, and contained expenditure within, the unit.
Seven management units were set up in York Health Authority in 1982. The Community Health Unit covered the same area as the former Community Sector but its functions were strengthened with the take over of duties formerly performed at area level. It also included the management of St Monica's and Selby War Memorial Hospitals. Two Mental Handicap Services Units were set up in 1982: one covering Claypenny Hospital and its related hostels, and one covering Whixley Hospital with Ripon Hostel. This foreshadowed the transfer of Whixley and Ripon Hostel in 1983. Two Mental Illness Units were set up: one to cover Naburn and Bootham Park Hospitals and one to cover Clifton Hospital. The Geriatric Unit covered City Hospital but excluded beds at the District Hospital and in the Community Health Unit. The York District Hospital Unit covered that hospital separately and included maternity services since these were to be transferred from Fulford Maternity Hospital in 1983. Two nurse managers were included in the District Hospital management team: one covering general nursing and one covering midwifery.
Arrangements for medical advisory machinery were reviewed. At district level the district management team included a representative for GPs and one for consultants. However, since the provision of a district medical committee was no longer a statutory requirement, it was decided that one would only be appointed for specific purposes as and when required. The former 'cogwheel' machinery embodied in the Medical Executive Committee and its divisions, covering hospital doctors, continued to exist, but a new community division was added to represent doctors working in community health activities and doctors in community medicine working in the district. A representative of the general practitioners was also invited to attend Medical Executive Committee meetings. The District Medical Subcommittee of the Local Medical Committee continued to be the main source of advice on matters affecting GPs. The subcommittee invited the chairman of the Medical Executive Committee to attend its meetings to represent hospital medicine.
Following the NHS Management Enquiry (Griffiths) Report of 1983 which advised that the NHS should be run more like a business organisation, a general management approach was instituted during the mid-1980s. The changes, which were generally in place by 1986, involved further restructuring. At district level the main changes included the appointment of a district general manager and the end of consensus teams. General management was introduced throughout the hierarchy, with the maximum delegation downwards. Units of management were generally reduced in number. A district general manager in York Health Authority was appointed in January 1985. Three hospitals and health services management units were created: the General Hospital Unit, the Mental Health Services Unit, and the Community and Mental Handicap Services Unit. Each of these was headed by a unit general manager responsible to the district general manager. Below the unit general managers the structures of each unit differed according to its nature and approach. The unit became the basis for nursing services with a director of nursing services under each unit general manager. However, an advisory post, the district nursing advisor, was created to advise the health authority.
The district management team and the unit management teams were abolished. At district level the team was replaced by a Policy Advisory Committee composed of a number of the chief officers. Health care planning teams were replaced by partnership groups (for joint planning at strategic level) and task groups (to be used by unit general managers to explore specific issues prior to discussion with a partnership group).
There were other changes. The department of community health was reorganised in 1987 with the district medical officer being replaced by a medical policy advisor. Professional medical advisory machinery was reorganised. A GP and a consultant representative were each made members of the policy advisory group, attending health authority meetings and participating in policy-making activity. A new District Medical Committee was set up to advise the district general manager and the health authority on matters of medical policy. This contained the consultants' and general practitioners' district representatives as well as the district medical officer (later medical policy advisor), other consultant representatives and the district general manager. At unit level, the General Hospital Unit and the Mental Health Services Unit each had an elected medical representative to work closely with the unit general manager, while in the Community and Mental Handicap Services Unit a GP representative fulfilled the same role. There were also the Medical Executive Committees in each unit to co-ordinate medical advice within the units.
A new structure was created to oversee internal staffing matters, with a new District Consultative and Negotiating Committee replacing a number of individual joint consultative staffs committees. New officers were also created in the changes of the late 1980s, including a director of planning, a director of information services, a director of estates and support services, a director of personnel, and a director of finance (the former treasurer).
The Acheson Report 'Public Health in England' (January 1988) recommended changes in the arrangements made by health authorities for the performance of their public health responsibilities, including the appointment of a director of public health, greater planning, co-ordination and measurement, and the publication of an annual report on public health. A director of public health for York Health Authority took up post in 1990, a first annual report having been published in 1988.
A further reorganisation of the general management units of the York Health Authority took place in the late 1980s. A new Community Health Services Unit included all community services together with Clifton Hospital, City Hospital and Claypenny Hospital. The new Medical Services Unit included all medical services and acute mental health services. The new Surgical Services Unit comprised all surgical services within the Authority.
After the NHS reorganisation of the early 1990s and the introduction of the internal market (see below), district health authorities were fundamentally changed in character, and became purchasers of health care for their resident populations. Under the NHS and Community Care Act of 1990, health authorities were reduced in composition, to a chairman and five non-executive members (appointed by the Secretary of State and the regional health authority) with other (up to five) executive members, appointed by this body and including the district general manager and district director of finance. The last meeting of the old-style larger York Health Authority took place in July 1990.
In April 1992, York Health Services NHS Trust took over the hospitals and community services formerly managed by York Health Authority. York Health Authority remained in existence as a purchaser body until the end of 1992, holding its last meeting in November 1992. In December 1992 a new authority, the North Yorkshire Health Authority was approved. This combined the former purchaser authorities of York, Harrogate, Scarborough, Northallerton and the Craven area of Airedale. This creation formed part of the Yorkshire Region plan to create a number of large purchasing authorities out of what had been seventeen smaller ones.
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- York Health District (Subject)
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