Administrative organisation

The capacity of the NHS for securing the best use of resources through rational planning and efficient operation has not been fully realised, for three main reasons. First, and perhaps most important administratively, has been the untidy division of the service under different types of authority. Secondly, there is the clinical independence of senior medical staff, which has weakened the formal management structures and left a no man’s land of blurred and shifting responsibilities in the costly hospital sector. Finally, and partly as a result of the other factors, there has been insufficient concern throughout the service with evaluation and review, and too much reliance on incremental planning and political decision making. The reorganisation in April 1974 is intended to secure improvements in each respect.