Even at the start of the National Health Service's existence in 1948 it was realised by many of those employed in it that its tripartite division into hospital, local authority and executive council services, was to some extent unsatisfactory. Although the 1946 Act establishing the NHS represented a skilled and workable compromise between the interests and beliefs of the various groups involved in health care planning and delivery at that time, developments over the past 25 years have made a structural reorganisation increasingly necessary. The dominance of hospital based attitudes and values throughout the NHS and poor liaison between staff working in the community services and those in the hospitals have led to imbalances in the standards of care. The problems of the handicapped and the chronically ill in particular have received unsatisfactory attention.
Since the beginning of the 1960s, notably with the publication of the Porrit report in 1962, overt pressure for the integration of the three branches of the NHS has been growing. In 1968 the then Labour Government expressed its intention to act towards this end with the publication of the first of its two Green Papers on the NHS. The subsequent Conservative Government concurred with the view that reform was necessary and so, after the publication of a Consultative Document in 1971 and the White Paper of 1972, the NHS Reorganisation Act was drafted and finally passed through Parliament in the summer of 1973.
There are major differences between this recent legislation and that of 1946, both in content and background. For example, in 1946 the country was recovering from the enormous social and economic trauma of the Second World War. The radical concept of a state run health service providing universally available care of equal standard to all those in need underlined the differences between pre-war and post-war Britain. By contrast the 1973 Act involved the reorganisation of an existing and widely acclaimed service into which thousands of millions of pounds have been channelled during the past quarter of a Century of relatively stable national development.
Hence 1974 should be regarded as a single part of the ongoing evolution of our 'welfare state' health services rather than as an isolated event. This paper describes the major characteristics of the reorganisation, confining its analysis mainly to the situation in England, in the light of the above knowledge.