Mrs Bottomley stopped short of committing the Government to retaining the bodies indefinitely. But she set a deadline of April next year for regional health authorities (RHAs) to 'slim down' and to shed about 5,200 administrative and clerical posts. Many NHS trust executives and some Tory right-wingers have been pressing the Government to abolish the RHAs altogether to give a freer rein to market forces in the new NHS.
Each region will be told to cut down to 200 an average workforce of 560 people, Mrs Bottomley told a conference of NHS managers, organised by the National Association of Health Authorities and Trusts, in London.
Sir Duncan Nichol, NHS chief executive, hopes to avoid large-scale redundancy programmes by transferring some staff to the district health authorities, or other health service bodies. The six NHS management executive 'outposts' that monitor the performance of NHS trusts are likely to employ some regional health authority staff whose jobs will disappear, as their scrutinising role expands in line with the growth of trusts.
Mrs Bottomley told the conference that RHAs would retain some public health and planning responsibilities following the review, which must report to ministers by the summer. They would also continue to monitor closely the activities of the purchasers - the district health authorities and the GP fundholders. 'They must maintain strategic oversight in their region to ensure a comprehensive range of NHS services remains available to all,' she said. 'We are all publicly accountable. We cannot sacrifice probity for some 'flash in the pan' gain.'
Sir Duncan told the managers that they must not 'take your eyes off the basics about good public sector management', nor forget that they were custodians of large sums of public money.
David Blunkett, Labour's health spokesman, said that Mrs Bottomley's failure to resolve finally the future of the regions was further evidence of her inability to make clear-cut decisions.
'The Secretary of State's decision to keep the RHAs and the 'outposts' while ordering a further review is a sign of befuddled thinking, and unfought battles in the Cabinet,' he said. 'The growing confusion in the relationship between the Department of Health, the regions, the NHS management executive and its outposts is set to continue.'
The Institute of Health Services Management criticised the minister's decision to order job cuts before the outcome of the review was known. Pamela Charlwood, director of the institute, said: 'It is not necessarily helpful to start with a number and then work out the work to be done.'
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