Never mind the new NHS reforms, the biggest one of all heralded massive changes in 1974. They don't make them like that any more, reminisces Steve Ainsworth
For old lags like me the word 'reorganisation' refers to only one event: the reorganisation of the NHS on 1 April 1974. Sadly the silver jubilee of that extraordinary day looks set to be eclipsed by the inauguration of primary care groups.
The past decade has witnessed so much change - the new GP contract, trusts, the appearance and disappearance of family health services authorities - it's easy to forget that for the first half of its life, the NHS suffered little significant change.
Many of those who have joined the NHS since 1974 seem unaware that from 1948 to 1974 the NHS was organised on a quite different basis to today: 175 local authorities had responsibility for community services such as district nurses and family planning, as well as providing public health services headed by the local medical officer of health. Hospital services were run by 15 regional hospital boards, 330 hospital management committees and 36 boards of governors of teaching hospitals, while GPs, dentists, chemists and opticians contracted with 135 local NHS executive councils. Amazingly, more than 12,000 members sat on those various boards and councils.
The reorganisation juggernaut started rolling on 23 July 1968 with a government green paper, The NHS: the administrative structure of medical services in England and Wales. The outcome was the NHS Reorganisation Act of 5 July 1973 (appropriately the 25th birthday of the NHS) which led to wholesale reorganisation. A major element of this was a geographical reorganisation to match the new local authority boundaries created in the simultaneous shake-up of local government.
County boroughs would disappear, even if some would live on as the centre of larger bodies. Goodbye Hull, hello Humberside; farewell Huddersfield and Dewsbury, welcome Kirklees. Whole new counties came into being while ancient names vanished forever. In Scotland similar changes were afoot.
In the NHS, community health councils appeared, while new area health authorities took on the work previously done by local authorities and hospital management committees. Family practitioner committees replaced executive councils.
I played out my own small part in the doomed borough of Grimsby. The executive council for which I then worked as registration supervisor on a salary of£1,250 employed a grand total of eight staff, who were all to become employees of the new Humberside area HA - though placed at the permanent disposal of the equally new Humberside family practitioner committee.
If Grimsby was a loser then Kingston-upon-Hull was the winner. The great and the good had decided that the new county of Humberside should incorporate most of the East Riding of Yorkshire and the northern part of Lincolnshire, artificially joined by the still-to-be-completed Humber Bridge. Over the following eight months Hull, the new centre of our small world, began like some monstrous leach to slowly suck away our lifeblood.
The marvellous crop-haired polymath who had led our tiny band for the preceding two years was taken from us immediately. He had kept our spirits high during Ted Heath's extraordinary three-day week - not to mention the traumas of 20 per cent inflation, flared trousers, long hair and even longer sideburns, the cod war and Watergate. Now he was called away to higher things in the administrative maelstrom of London.
Our financial and legal responsibilities were plundered on day one and the six staff remaining in the office were placed in the temporary care of an ageing battle casualty from the East Riding office. He quickly made good use of his enforced exile by occupying the board room and turning it into a workshop where he vainly attempted to repair a terminally ill colour television set. More ambitiously, he commandeered our heated medical record storage annex, where he parked the mouldering carcass of a large, black almost-vintage car from under which he would periodically emerge, covered in engine oil, to take one of the few telephone calls that still came our way.
What did people think of it all? In January I'd been for a job interview in Nottingham and asked my fellow interviewees what they thought of the impending changes. 'It's just a take-over by the bloody hospitals,' the most senior and experienced candidate told me. He got the job - no doubt on the grounds that he had a far better grasp of current affairs than I did.
Looking back I'm sure that cynical assessment was correct. Though there were few redundancies when the music did stop, the best chairs were almost exclusively occupied by those with backgrounds in hospital management committees. Medical officers of health who had enjoyed independent fiefdoms were often treated as second-class citizens in the new structure, while in many areas conflicts between those managing the new family practitioner committees and the new area health authorities were not resolved until the false dawn of FPC independence 11 years later - only to flare again in the final annihilation of FHSAs another 10 years on.
One new baby made almost universally unwelcome was the community health council. 'Why does the NHS need such a thing when we have lay members to represent the public?' was a question I often heard in the following years - it took at least until the late 1980s for CHCs to become truly valued and appreciated for their real contribution to the NHS.
Every reorganisation takes time to sort out - 1974, the most profound reorganisation of all, inevitably took the longest. The changes did not and could not happen overnight - it took the best part of 10 years, for example, to desegregate the patient data records held in the 'Wembley Complex', which covered general practices for most of London. By then, another reorganisation was on the way.
Even now, 25 years on, those seeking information from before 1974 will often find that files are inexplicably incomplete or lost. The human cost of change, too, was incalculable. Most managers survived and even enjoyed a short-lived affluence as they gained significant promotions, though only to find their worth quickly eroded as inflation soared to almost 30 per cent. But survival was often at the expense of uprooting families and relocating to unfamiliar parts of the country.
But at the time, few doubted the effort was worthwhile. The tripartite structure and county boroughs were undoubtedly anachronisms. 'No pain, no gain' is an expression which might have been expressly invented for those trying valiantly to sort out the confusion. And many of those doing the job did take consolation in the naive belief that surely this would be the only time in their lives that such an awesome task would need to be faced. Perhaps, too, the workers were encouraged by the January 1974 new year message from social services secretary Sir Keith Joseph, who expressed his certainty that staff would 'find great satisfaction in rising to the challenge'.
Anyone who had found their gorge rising - rather than their satisfaction - no doubt took some comfort in the fact that Sir Keith, along with the Conservative government, did not survive until the 'appointed day'. It fell to the new Labour social services secretary Barbara Castle to inaugurate the new NHS on 1 April.
As for me, before the end of the year I'd found promotion and another job in far-away Stockport. On the last Thursday in November 1974 I helped pack the furniture and files for the Pickfords van to Hull. That afternoon, in an empty echoing office we happy few held a small wake before I left to board my train. I never returned.
If anyone still wants to know what happened to those missing bottles of sherry left over from the very last meeting of the Grimsby executive council on the evening of Thursday, 28 March 1974 - or about the streaker spotted on the seafront at Cleethorpes in the early hours of the following morning - it had absolutely nothing to do with me, honest.
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