Mrs Bottomley has successfully resisted the pressure from the Thatcherite wing for the regions to be abolished to give free rein to competition between hospitals in the NHS. 'She does not want a free-for-all,' one insider said.
The regions are to be streamlined, with cuts in staffing, and will lose most of their powers to intervene in the day-to-day running of the NHS hospitals. They are to be given a 'light touch' role in monitoring the services provided by the hospitals and fund-holding GPs.
The decision to keep the regions as an interim tier underlines the concern among ministers about the need to retain some control over the market for NHS health care, which has led to accusations of queue jumping. 'They are discussing the details of how much power the regions will keep,' a ministerial source said.
Under the Government's changes to the NHS, the internal market was established by splitting the providers of health care - hospitals and GPs - from the purchasers, the district and regional health authorities.
The majority of NHS hospitals have opted out of local authority control to become self-governing NHS trusts. But hospital managers resented interference by the top tier of bureaucracy in their day-to-day decisions.
The regions will be stripped of some of their powers to intervene in management decisions, but will act as an early warning system where there is a threat that services by hospitals could break down, damaging patient care.
'If one hospital trust looked as though it was likely to lose half its workload and was threatened with closure, then the regions would warn the NHS management board,' the source said.
Mrs Bottomley's officials supplied a policy paper to the Downing Street policy unit for the Prime Minister's meeting with his officials at Chequers at the weekend. Mr Major endorsed the plan yesterday at his bilateral meeting with Mrs Bottomley, but details are not expected to be announced until next month.
In spite of continuing protests about shortages of funds, Mr Major sees the NHS - traditionally a vote-loser for the Tories - as one of the areas where he can regain the initiative on domestic policy.
The shake-up of the regions, which will not require legislation, will come as Mrs Bottomley faces her sternest test over the closure of some famous London teaching hospitals, the introduction of care in the community, and protests over appeals by some hospitals that are likely to exceed their budgets before the end of the financial year.
Mrs Bottomley is confident she can win the public relations battle over reorganisation of health care in the capital by boosting primary care services in London before the long-term hospital closures take place. In spite of criticism by the right wing, colleagues believe that she has gained authority with a difficult portfolio for the Tories, and demonstrating she can take tough decisions will enhance her reputation.Reuse content