When the white paper on the reorganisation of the NHS in England appeared, the Lancet commented that it was ‘welcome and wise’.

It had been a long saga, with two green papers, a background of reorganisation in the social services, and changing governments.

Coming into effect on 5th April 1974, it was the product of the Conservatives, but it fell to Labour - elected shortly before the appointed date - to accept it or go back to the drawing board.

The English regional hospital boards (RHBs) were reconstituted, with minor boundary changes, as 14 regional health authorities (RHAs). Their role was strengthened and they were responsible for strategy, the building programme, staffing matters and the allocation of resources to their 90 subordinate area health authorities (AHAs). Local authority health departments, hospital management committees and the teaching hospital boards of governors were replaced by the AHAs, each coterminous with one of the 90 new local authorities.

A letter writer to the Lancet wrote: “The whole business is being viewed with much less than fervent optimism by many of us who actually come into contact with patients - the ‘grass roots’ of the service. And let’s face it, grass roots puts us in our place, as low down as you can get. From our lowly viewpoint the NHS looks like a particularly nervous colony of ants which has just had a particularly large garden fork shoved in and stirred around.”

The stirring up had only just begun.

For a fuller account of the events, see www.nhshistory.net