At last week’s EMIG Quarterly meeting Donal Markey, Assistant director of Programmes, Transformation and Performance, said that the Irish health service had been reorganised just once while England’s NHS had been reorganised 7 times.
As we are in our Silver Anniversary year and nostalgically looking back over our business, we thought a look back over the major NHS reorganisations would be interesting. Here Charles Joynson highlights the key shifts in governance, structure and ideology.
Each reorganisation reflects deeper tensions: central control vs local autonomy, public service vs market logic, and short-term fixes vs long-term strategy.
1948 – NHS Founded
- National Health Service Act 1946 comes into force on 5 July 1948.
- NHS is launched as a fully nationalised system, with services free at the point of use.
1974 – First Major Reorganisation
- Introduction of Regional Health Authorities (RHAs) and Area Health Authorities (AHAs).
- Aimed to improve coordination between hospital and community services.
1982 – AHAs Abolished
- AHAs replaced by District Health Authorities (DHAs).
- Move toward streamlining and cost-cutting.
1990 – Internal Market Introduced
- NHS and Community Care Act 1990 creates a purchaser-provider split (Fund holding).
- Health authorities become purchasers; hospitals become providers.
- Marks the beginning of market-style reforms.
2002 – Strategic Health Authorities (SHAs)
- SHAs replace RHAs, overseeing newly created Primary Care Trusts (PCTs).
- PCTs take on commissioning responsibilities from health authorities.
2006 – Foundation Trust Expansion
- Push for NHS Foundation Trusts, giving hospitals more autonomy.
- Emphasis on competition and performance metrics.
2012 – Health and Social Care Act
- PCTs and SHAs abolished.
- Creation of Clinical Commissioning Groups (CCGs) led by GPs.
- NHS England established as an independent body.
- Significant shift toward decentralisation and competition.
2022 – Integrated Care Systems (ICSs)
- Health and Care Act 2022 formalise ICSs.
- CCGs replaced by Integrated Care Boards (ICBs).
- Focus shifts to collaboration over competition, aiming to integrate health and social care.