The shake-up, disclosed in three Department of Health reports, centres on the replacement of 14 regional health authorities with a central NHS Executive and eight all-purpose regional offices, each with a maximum staff of 135. That change alone will see the eventual disappearance of about 1,500 jobs, in addition to the 1,300 lost over the past six months.
There will also be what officials called 'substantial reductions' - likely to be at least a further 500 - in staff at the executive headquarters in Leeds and the rest of the health department. Under the overhaul, the NHS Executive will be responsible, for the first time, for developing policy as well as implementing it.
The streamlining does not alter the fact, however, that the purchaser-provider split at the heart of the Government's reforms has called for thousands of new local hospital managers to conduct costings and negotiate contracts.
The latest wave of job losses is due to begin in the autumn and staff were being briefed on the changes yesterday. Officials said that they hoped to avoid compulsory redundancies. According to a government source, total savings are expected to approach pounds 200m.
The move was timed to follow John Major's speech on Wednesday night, promising the thinning out of layers of NHS management. The fight is now on for Virginia Bottomley, Secretary of State for Health, to ensure the money is all channelled into patient care, not sacrificed to Treasury pressure for public spending cuts.
Mrs Bottomley will call for the honouring in full of the 1992 election manifesto, which pledged, year by year, to 'increase the level of real resources committed to the NHS. Savings made through greater efficiency will be ploughed back . . .'
Dawn Primarolo, Labour's health spokeswoman, said: 'Instead of using clerical workers as a scapegoat, (Mrs Bottomley) should accept it is her changes that have created this bureaucratic monster. The only lasting solution is to abolish the internal market.'
It was John Redwood, the Secretary of State for Wales, who was the first to focus on the numbers of 'men in grey suits' eating into valuable NHS resources. Yesterday, he launched a second edition of the Patient's Charter for Wales, while revealing that his own onslaught against top-heavy administration in the principality had seen the pruning of 91 posts in management and clinical grades out of a total administrative workforce of 1,200.
Consultation is continuing over the proposed slimming-down of the 17 Welsh district health authorities and family health services authorities into either three, five or eight new bodies. Mr Redwood favours the most radical option of three.
More controversially, Mrs Bottomley and Mr Redwood are in discussions with the British Medical Association over plans for locally set performance-related pay for doctors - starting with hospital consultants - from next April, to which the BMA is adamantly opposed. It says that the scheme, which could involve bizarre comparisons of treatment and death- rates, would be impossible to administer fairly.Reuse content