The Bottomley Years

1989: Launch of Working for Patients; appointment of Duncan Nichol to head new NHS management executive; general management introduced in family practitioner committees; ambulance strike; launch of Caring for People: community care in the next decade and beyond.

1990: NHS and Community Care Bill becomes law; regional health authorities reconstituted with smaller memberships; new-style health authorities set up; FPCs become family health services authorities; broad agreement with medical profession to cut junior doctors' hours.

1991: Graham Hart becomes DoH permanent secretary; management executive

publishes Integrating Primary and Secondary Care; NHS reforms and first stage of Caring for People reforms - 57 trusts and 306 fundholders join first wave; Patient's Charter sent to every home in England.

1992: NHS women's unit launched; regional DoH 'outposts' set up to monitor trusts; second-wave trusts and fundholders; Conservatives win general election; King's Fund reports on London's NHS; launch of The Health of the Nation; Tomlinson report calls for 7,000 fewer acute hospital beds in London.

1993: London Implementation Group set up to bring in Tomlinson; RHAs told to cut staff to 200; third wave of trusts; community care reforms implemented in full; plans to cut RHAs from 15 to eight, and to set up new NHS Executive; HAs and FHSAs 'encouraged' to merge.

1994: trusts number 419, fundholders nearly 9,000; eight regional offices set up; Alan Langlands

succeeds Duncan

Nichol; Wilson report on NHS complaints; concept of 'primary care-led purchasing' launched; DoH 'downsized' by 21 per cent.

1995: Board appointments made 'more open' in wake of Nolan report; first round of local pay; Code of Openness for NHS; Tory MPs revolt over plan to close Bart's; Audit Commission proposes six ways to

measure management costs; Mrs Bottomley departs for Department of National Heritage.