Reorganization of the National Health Service: Background and Issues in England's Quest for a Comprehensive-Integrated Planning and Delivery System

The first major reorganization of the National Health Service since its founding in 1948 will take place on April 1, 1974. Three major objectives are involved: the consolidation of the tripartite structure into a single unified system, the strengthening of management processes, and the expansion of machinery for making health services more responsive to local needs. While generally supportive of the reorganization, this assessment of the changes in policy and structure identifies a number of constraints in the form of political realities and organizational-administrative capabilities which may limit the attainment of objectives. In particular, the bias in modern medicine for hospital-based specialization, the uneven power relationships among competing professional interests, and the continued separation of health from social services are seen as restricting policy aimed at altering the balance between primary, secondary, and tertiary levels of care and between curative and "carative" services.