'Dinosaurs from a bureaucratic past'

'AT BEST they are dinosaurs, relics of the centralised bureaucratic past of the NHS,' Roy Lilley, chairman of the Homewood NHS Trust, in Surrey, declares of the 14 English regional health authorities. 'They have no future.'

The monolithic health regions, created in 1974 by Sir Keith Joseph, then Minister for Health, must be laid to rest if the new market in NHS health care is to flourish, Mr Lilley argues. 'I have calculated that the South East Thames RHA spends pounds 12,500 every second of the working day, and it is difficult to see how they contribute anything worthwhile.'

As a self-governing NHS trust, serving mentally ill and handicapped people, Homewood's work is driven by the contracts it negotiates with purchasers, the GP fundholders and health districts. It sees little need for outside interference beyond the monitoring and strategic planning consultations carried out by the NHS management executive 'outposts'. These six units, established last year and employing only 38 people, have more of a trouble-shooting role, acting as the 'eyes and ears' of NHS officials reporting to ministers.

Although most of the NHS will be under the control of trusts from April, not all adopt Mr Lilley's dismissive line on the health regions. John Greetham, who has just stepped down as chairman of the NHS Trust Federation, believes their functions should be cut and the number reduced to eight, nine or ten.

'The NHS is spending millions of pounds more on bureaucracy than it needs to, money that should be going towards treating more patients. The regions must learn to free up and lose some of these jobs,' he said. 'There is a lot of nervousness about who is doing what to whom, so the sooner a decision is made, the better.'

Virginia Bottomley, Secretary of State for Health, has been considering changes since the middle of last year, and is expected to announce a decision next month.

Phillip Hunt, director of the National Association of Health Authorities and Trusts, says it is too early to write off the regions. 'You could carry on just with the 'outposts', but you would lose the element of public involvement. Decision-making would be sucked more towards the centre,' he said.

'You do need a tier of administration that maintains that involvement, but also enhances accountability and ensures that relationships do not get too cosy between the purchasers and the providers of health care, and that there is genuine competition.'