Is the DHSS signing off?
Authors: N Ellis
Journal: BMJ (1981)

We are determined to see that as many decisions as possible are taken at the local level.1 The implications of this and other ministerial statements emphasising the dual themes of devolu? tion and local autonomy seem to have fallen on deaf ears. This fundamental change of view, which occurred in May 1979, has been disbelieved or unnoticed in some quarters. This is not entirely accidental, since the interests of those who wish to reduce the impact of this policy are best served if the change is implemented by stealth. The change is evident in the contrast between the 173-page  Book2 and the seemingly endless flow of over a hundred circulars that poured out of the Health Departments during the 1974 reorganisation, and the seven-page circular on Health Service development structure and manage? ment8 accompanied by a promise of little more to follow, issued in July 1980. In 1974 the DHSS produced a blueprint for the Service which described in detail the structure of management and inter? professional relations. The complexity of the Grey Book's diagrams of management structure?appropriately described as exhibits?makes the plan of the Paris Metro look quite simple. The Government does not intend to repeat the experience of 1974 and will not be laying down central prescriptions for the Service. The DHSS no longer sees itself as all knowing and all wise, capable of establishing working relations between the various groups in the Service. Because the 1974 reorganisation weakened hospital administration the Department was irresist? ibly drawn into prescribing what should happen at the local level. For the 1982 reorganisation the Department will issue only the minimum of guidance. The process of reorganisation is now left to local initiative. This emphasis on local autonomy was made in a recent ministerial statement outlining the considerably reduced function of the regional health authority. The Secretary of State, Mr Patrick Jenkin, said that he was determined to ensure that regional health authorities too are slimmed down and their functions reduced. This is essential if we are to advance the greater local autonomy we seek.4  new district health authority now has to decide for itself which managerial structure it should adopt. Each DHA should have wide discretion in determining its management arrangements. Accordingly, the prescription of particular posts contained in previous circulars is now withdrawn.3 The one remaining prescription is simply that there should be a district management team, consisting of a community physician, nurse, treasurer, administrator, con? sultant, and general practitioner, and that each authority should arrange its services into units of management, each with an administrator and a director of nursing services. The composition of the district management team will therefore remain un? changed. What posts are at risk? The various hierarchies originally prescribed by the DHSS for the professions supplementary to medicine could well wither or disappear in many districts. For example, the existing area and district level posts in chiropody, dietetics, the remedial professions, speech therapy, radiography, and health education are probably at risk. No doubt each of these groups will argue that their particular circumstances merit a special circular from the centre. But such special pleading will