1290
authority would have, by nomination, a consultant, a general practitioner, a nurse, a university representative, and someone from the trade union movement, but disauthorities. Each
National Health Service DISTRICT HEALTH AUTHORITIES THE report of the
Royal Commission on the National which was published five months ago, Health Service, contained more than a hundred recommendations. In its first reaction’ to the report the Government concentrates on only one of them. Many issues are "being studied by the Health Departments through the ordinary machinery". Some possibilities mentioned by the Royal Commission are rejected: regional health authorities are not to be made accountable to Parliament; the N.H.S. will not be handed over to local government; there is to be no additional inquiry into the London health services ; health authorities are not to have chief executives; family practitioner committees are let out of the condemned cell. The only Royal Commission proposal seized on with any enthusiasm is the abolition of the area health authority. In a foreword to the consultative paper, Mr Patrick Jenkin, Secretary of State for Social Services, and Mr Nicholas Edwards, Secretary of State for Wales, say: approach stems from a profound belief that the needs of patients must be paramount. Whatever structure and management arrangements are devised must be responsive to those needs. The closer decisions are taken to the local community and to those who work directly with patients, the more likely it is that patients’ needs will be their prime objective." District health authorities.-With regional health authorities staying as they are, for the time being at least, only one authority would remain in the N.H.S. in England, and this would be at district level serving populations in the range 200 000 to 500 000. Some districts and areas (notably singledistrict ones) would fit the bill already but most multi-district areas will need restructuring, wherever possible along the lines of existing district boundaries. Social geography (e.g., not cutting through established community identities), hospital catch"Our
scale of facilities, and links with local government are the factors to be taken into account when restructuring is discussed. Teaching districts would be too small to meet the requirements of medical schools, so universities would be asked to forge links with more than one of the new authorities. The new authorities would be smaller in membership than the present area ones, and might have twenty members plus a chairman. Local authority representation would be reduced from a third (in A.H.A.s) to about one fifth in the new district ment areas,
trict health staff would not have the right of employee representation. The chairman would be nominated by the Secretary of State and the balance of members by the R.H.A.
Timing.-After the consultation process, the details would be handed over to R.H.A.s which would have until the end of 1983 to implement the structural changes needed. Management arrangements would take even longer since nothing could be done in new districts until they had been set up. Cost.-When the transitional costs (unspecified) have been the proposed changes "together with the general drive in the NHS for greater efficiency" should permit a reduction in management costs of up to 10%. From April 1, 1980, health authorities will be set new objectives for savings on the management side of the N.H.S.
met
Regional health authorities.-These will be responsible, after full consultation, for making proposals for the restructuring of areas. They will also, for the longer term, retain responsibilities for financial control and for coordinating strategic plans. Planning procedures should be simplified to make regional plans more sensitive to district needs. The regions will be expected to leave operational matters primarily to be settled by district health authorities. Family practitioner committees.-These should remain but, where appropriate, one F.P.C. may cover more than one district. Professional advice.-The simplification of the professional advisory committee structure is being looked into by a working-party under the Chief Medical Officer. Community health councils.-The Government is clearly tempted to do away with these councils-next year they will cost C4 million and the new authority members should be less remote from local services than A.H.A. members are-but it limits itself to an invitation to comment on whether C.H.C.s should be retained under the new district structure.
Consultants’ contracts.-There is a strong authorities to hold consultant contracts.
case
for district
Area services.-The changes have implications for ambulance and scientific services and the like, and R.H.A.s would have to approve splitting or sharing arrangements. Comments should be sent, by April 30, 1980, to Regional Liaison Division 5A, D.H.S.S., Euston Tower, 286 Euston Road, London NW3DN, or to the Welsh Office in Cardiff. 1.
Department of Health and Social Security and Welsh Office. Patients First: consultative paper on the structure and management of the National Health Service in England and Wales. H.M. Stationery Office. 1. l.
48.
Jenkins DJA, Leeds AR, Gassull MA, Houston H, Goff DV, Hill MJ. The cholesterol lowering properties of guar and pectin. Clin Sci Mol Med 1976; 51: 8P.
41. Albrink
MJ, Newman T, Davidson PC. Lipid-lowering effect of a very high carbohydrate high fiber diet. Diabetes 1976; 25 (suppl): 324A. 42. Jenkins DJA, Leeds AR, Slavin B, Mann J, Jepson EM. Dietary fibre and blood lipids: reduction of serum cholesterol in type II hyperlipidæmia by guar gum. Am J Clin Nutr 1979; 32: 16-18. 43. Jenkins DJA, Reynolds D, Slavin B, Leeds AR, Jenkins AL, Jepson EM. Dietary fiber and blood lipids: treatment of hypercholesterolemia with guar crispbread. Am J Clin Nutr 1979 (in press). 44. Miettinen TA, Tarpila S. Effect of pectin on serum cholesterol, fecal bile acids and biliary lipids in normolipidemic and hyperlipidemic individuals. Clin Chim Acta 1977; 79: 471-77. 45. Kritchevsky D. Fiber, lipids and atherosclerosis. Am J Clin Nutr 1978; 31: 565-74. 46. Barnard DL, Heaton KW. Bile acids and vitamin A absorption in man: the effects of two bile acid binding agents, cholestyramine and lignin. Gut 47.
1973; 14: 316-18. Jenkins DJA. The action of dietary fibre in lowering fasting
serum cholesterol and reducing postprandial glycæmia: gastrointestinal mechanisms. In: Carlson LA, et al. eds. International Conference on Atherosclerosis. New York, Raven Press 1978: 173-82.
49. Heaton KW, Pomare EW. Effect of bran on blood lipids and calcium. Lancet 1974; i: 49. 50. Jenkins DJA, Hill MS, Cummings JH. Effect of wheat fiber on blood lipids, fecal steroid excretion and serum iron. Am Clin Nutr 1975; 28: 1408-11. 51. Reinhold JG, Parsa A, Karimian N, Hammide JW, Ismail-Beigi F. Decreased absorption of calcium, magnesium, zinc, and phosphorus by humans due to increased fibre and phosphorus consumption as wheat bread. J Nutr
1976; 106: 493. 52. Pak CW, Delea CS, Bartter FC. Treatment of recurrent nephrolithiasis with cellulose phosphate. N Engl J Med 1974; 290: 175. 53. James WPT, Branch WJ, Southgate DAT. Calcium binding by dietary fibre. Lancet 1978; i: 638-39. 54. Jenkins DJA, Reynolds D, Wolever TMS, Nineham R, Taylor, RH, Hockaday TDR. Diabetic control, lipids, and trace elements after six months on guar. Clin Sci 1979 (in press). 55. Jenkins DJA, Wolever TMS, Bacon S, et al. Diabetic diets: high carbohydrate combined with high fiber. Amer J Clin Nutr (in press). 56. Jenkins DJA, Taylor RH, Nineham R, et al. Combined use of guar and acarbose in reduction of postprandial glycæmia. Lancet 1979; ii: 924.
authority would have, by nomination, a consultant, a general practitioner, a nurse, a university representative, and someone from the trade union movement, but disauthorities. Each
National Health Service DISTRICT HEALTH AUTHORITIES THE report of the
Royal Commission on the National which was published five months ago, Health Service, contained more than a hundred recommendations. In its first reaction’ to the report the Government concentrates on only one of them. Many issues are "being studied by the Health Departments through the ordinary machinery". Some possibilities mentioned by the Royal Commission are rejected: regional health authorities are not to be made accountable to Parliament; the N.H.S. will not be handed over to local government; there is to be no additional inquiry into the London health services ; health authorities are not to have chief executives; family practitioner committees are let out of the condemned cell. The only Royal Commission proposal seized on with any enthusiasm is the abolition of the area health authority. In a foreword to the consultative paper, Mr Patrick Jenkin, Secretary of State for Social Services, and Mr Nicholas Edwards, Secretary of State for Wales, say: approach stems from a profound belief that the needs of patients must be paramount. Whatever structure and management arrangements are devised must be responsive to those needs. The closer decisions are taken to the local community and to those who work directly with patients, the more likely it is that patients’ needs will be their prime objective." District health authorities.-With regional health authorities staying as they are, for the time being at least, only one authority would remain in the N.H.S. in England, and this would be at district level serving populations in the range 200 000 to 500 000. Some districts and areas (notably singledistrict ones) would fit the bill already but most multi-district areas will need restructuring, wherever possible along the lines of existing district boundaries. Social geography (e.g., not cutting through established community identities), hospital catch"Our
scale of facilities, and links with local government are the factors to be taken into account when restructuring is discussed. Teaching districts would be too small to meet the requirements of medical schools, so universities would be asked to forge links with more than one of the new authorities. The new authorities would be smaller in membership than the present area ones, and might have twenty members plus a chairman. Local authority representation would be reduced from a third (in A.H.A.s) to about one fifth in the new district ment areas,
trict health staff would not have the right of employee representation. The chairman would be nominated by the Secretary of State and the balance of members by the R.H.A.
Timing.-After the consultation process, the details would be handed over to R.H.A.s which would have until the end of 1983 to implement the structural changes needed. Management arrangements would take even longer since nothing could be done in new districts until they had been set up. Cost.-When the transitional costs (unspecified) have been the proposed changes "together with the general drive in the NHS for greater efficiency" should permit a reduction in management costs of up to 10%. From April 1, 1980, health authorities will be set new objectives for savings on the management side of the N.H.S.
met
Regional health authorities.-These will be responsible, after full consultation, for making proposals for the restructuring of areas. They will also, for the longer term, retain responsibilities for financial control and for coordinating strategic plans. Planning procedures should be simplified to make regional plans more sensitive to district needs. The regions will be expected to leave operational matters primarily to be settled by district health authorities. Family practitioner committees.-These should remain but, where appropriate, one F.P.C. may cover more than one district. Professional advice.-The simplification of the professional advisory committee structure is being looked into by a working-party under the Chief Medical Officer. Community health councils.-The Government is clearly tempted to do away with these councils-next year they will cost C4 million and the new authority members should be less remote from local services than A.H.A. members are-but it limits itself to an invitation to comment on whether C.H.C.s should be retained under the new district structure.
Consultants’ contracts.-There is a strong authorities to hold consultant contracts.
case
for district
Area services.-The changes have implications for ambulance and scientific services and the like, and R.H.A.s would have to approve splitting or sharing arrangements. Comments should be sent, by April 30, 1980, to Regional Liaison Division 5A, D.H.S.S., Euston Tower, 286 Euston Road, London NW3DN, or to the Welsh Office in Cardiff. 1.
Department of Health and Social Security and Welsh Office. Patients First: consultative paper on the structure and management of the National Health Service in England and Wales. H.M. Stationery Office. 1. l.
48.
Jenkins DJA, Leeds AR, Gassull MA, Houston H, Goff DV, Hill MJ. The cholesterol lowering properties of guar and pectin. Clin Sci Mol Med 1976; 51: 8P.
41. Albrink
MJ, Newman T, Davidson PC. Lipid-lowering effect of a very high carbohydrate high fiber diet. Diabetes 1976; 25 (suppl): 324A. 42. Jenkins DJA, Leeds AR, Slavin B, Mann J, Jepson EM. Dietary fibre and blood lipids: reduction of serum cholesterol in type II hyperlipidæmia by guar gum. Am J Clin Nutr 1979; 32: 16-18. 43. Jenkins DJA, Reynolds D, Slavin B, Leeds AR, Jenkins AL, Jepson EM. Dietary fiber and blood lipids: treatment of hypercholesterolemia with guar crispbread. Am J Clin Nutr 1979 (in press). 44. Miettinen TA, Tarpila S. Effect of pectin on serum cholesterol, fecal bile acids and biliary lipids in normolipidemic and hyperlipidemic individuals. Clin Chim Acta 1977; 79: 471-77. 45. Kritchevsky D. Fiber, lipids and atherosclerosis. Am J Clin Nutr 1978; 31: 565-74. 46. Barnard DL, Heaton KW. Bile acids and vitamin A absorption in man: the effects of two bile acid binding agents, cholestyramine and lignin. Gut 47.
1973; 14: 316-18. Jenkins DJA. The action of dietary fibre in lowering fasting
serum cholesterol and reducing postprandial glycæmia: gastrointestinal mechanisms. In: Carlson LA, et al. eds. International Conference on Atherosclerosis. New York, Raven Press 1978: 173-82.
49. Heaton KW, Pomare EW. Effect of bran on blood lipids and calcium. Lancet 1974; i: 49. 50. Jenkins DJA, Hill MS, Cummings JH. Effect of wheat fiber on blood lipids, fecal steroid excretion and serum iron. Am Clin Nutr 1975; 28: 1408-11. 51. Reinhold JG, Parsa A, Karimian N, Hammide JW, Ismail-Beigi F. Decreased absorption of calcium, magnesium, zinc, and phosphorus by humans due to increased fibre and phosphorus consumption as wheat bread. J Nutr
1976; 106: 493. 52. Pak CW, Delea CS, Bartter FC. Treatment of recurrent nephrolithiasis with cellulose phosphate. N Engl J Med 1974; 290: 175. 53. James WPT, Branch WJ, Southgate DAT. Calcium binding by dietary fibre. Lancet 1978; i: 638-39. 54. Jenkins DJA, Reynolds D, Wolever TMS, Nineham R, Taylor, RH, Hockaday TDR. Diabetic control, lipids, and trace elements after six months on guar. Clin Sci 1979 (in press). 55. Jenkins DJA, Wolever TMS, Bacon S, et al. Diabetic diets: high carbohydrate combined with high fiber. Amer J Clin Nutr (in press). 56. Jenkins DJA, Taylor RH, Nineham R, et al. Combined use of guar and acarbose in reduction of postprandial glycæmia. Lancet 1979; ii: 924.
