Annex A > Chapter 5 - Regional, District and Trust Management > Management structures throughout the period in question > The South Western Regional Health Authority (SWRHA)
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The South Western Regional Health Authority (SWRHA)
29 The 1973 Act established the SWRHA, which came into operation from 1 April 1974.
30 At that time, within the SWRHA were Avon Area Health Authority (Teaching) and a number of health districts. The Avon Area Health Authority (Teaching) included about 800, 000 people in the Bristol and surrounding areas. The BRI and the BRHSC were both contained within the Bristol Health District (Teaching) which served a population of about 360, 000 people, mostly within the Bristol area. [26]
31 Miss Catherine Hawkins, SWRHA Regional General Manager (RGM) from August 1984 to December 1992, explained the history of the SWRHA:
` ... the South West region had been there since 1974. In fact, longer than that: in 1948 there had been a regional authority. What had changed was that in 1984 general management was introduced at regional and district levels. So, there had always been a regional authority dealing with programmes and strategic planning and financial allocation but it changed in 1984 when general management was introduced, and it changed again in 1991.' [27]
32 The SWRHA was one of 14 different RHAs in England, and within its boundaries were 11 separate DHAs. Among those 11 districts were Bristol and Weston, Southmead and Frenchay, which between them covered 880, 000 population in the greater Bristol area. [28] The SWRHA itself spanned a far larger area, including Gloucestershire, Avon, Somerset, Devon, Cornwall and the Isles of Scilly. [29]
33 The RGM split the responsibilities within the SWRHA into five main areas (amongst others). These were, in general terms:
- Community Medicine (latterly called Public Health Medicine);
- Capital Planning;
- Service Planning;
- Finance; and
- Human Resources. [30]
34 Although the structure and organisation of the SWRHA changed over the period from 1984 to 1995, these main areas were always present in one form or another. For example, the Capital Planning and Service Planning departments merged and
de-merged from time to time. [31]
35 The Regional Treasurer of the SWRHA was responsible for all of the Region's financial matters, including resource allocation to the districts, monitoring the financial position of the districts and providing financial advice to the Regional Health Authority Board. [32]
36 Dr Marianne Pitman was the Regional Specialist in Community Medicine. This title later changed to Consultant in Public Health Medicine, but the main functions of the position remained the same. The number of consultants in public health medicine varied between one and three at the most, and they had secretarial and administrative support. Dr Pitman's line manager and head of the department was the Regional Medical Officer (RMO)/Regional Director of Public Health (RDPH), [33] to whom she was managerially and professionally responsible. The RMO/RDPH created the work programme for the year that was agreed with the regional team officers, who were the executive directors of the SWRHA. [34]
37 The consultant(s) in public health medicine liaised with the RMO, as well as the public health departments located within the DHAs. Direct contact with the trusts, once these were set up, was mostly through individual clinicians and associated managers.
38 The consultant(s) supported the Regional Hospital Medical Advisory Committee [35] (RHMAC) and later the Regional Primary Care Medical Advisory Committee (RPCMAC). The RMO attended each meeting. Dr Pitman attended when required. She also attended as an observer as many appropriate RHMAC sub-committee meetings as possible. This was not on a regular basis though, because the various different sub-committees were at times over 30 in number. Initially the RHMAC was made up of the chairmen of these sub-committees. Latterly, it was comprised of trust medical representatives with sub-committee chairmen attending as required or on request of the Chair. [36]
39 Dr Pitman's work with the RMO, as a result of attendance at these sub-committee meetings, was to provide support as required and to act as an additional conduit of information between the RMO and the sub-committee. However, not all matters would be channelled in this way. Any consultant could ask for an interview with the RMO if they had confidential issues which they wanted to discuss or impart instead of choosing to follow the route of raising the matter in committee or first with a consultant in public health medicine. [37]
40 However, it was Dr Alistair Mason's [38] experience as RMO that:
`It was very rare for consultants, whom I did not know, to come out of the blue with a particular problem concerning themselves or colleagues. Members of the medical advisory committees did on a number of occasions bring forward concerns about their colleagues.' [39]
41 The consultants in public health medicine were also involved in cross-RHA departmental strategic planning for service and capital developments. [40]
42 The role of consultant in public health medicine also involved Dr Pitman in the initiation procedures for setting up the supra regional service (SRS) of neonatal and infant cardiac surgery (NICS) in January 1984 and the discussions regarding its effect following its inauguration. [41]
Managerial relationships with the Department of Health
43 One of the main functions of the RHA was its role in strategic planning. According to Miss Hawkins, the RHA formed a view of which services should or should not be developed, taking into account national priorities passed down from the DoH/Department of Health and Social Security (DHSS) and the views expressed from the districts. [42]
44 The DoH/DHSS made their views and priorities known by issuing circulars and directives to the regions, and also through the medium of annual reviews which took place between the DoH and the Region. These reviews were between the Minister and the Chairman of the RHA. The Vice-Chairman would also normally attend, together with the RGM and the appropriate members of the RGM's team. As Miss Hawkins explained, the Minister would lead the departmental team, supported by civil servants as necessary. [43]
45 The purpose of the meetings was to review different aspects of healthcare according to the particular interests a particular Minister may have had:
` ... but there was always a thread running through it [the meeting] about financial viability and how we had performed against national targets, whether we were achieving our overall strategic plan and whether there were any specific items of interest or concern on either side. It was a very open type of meeting where you could argue back, but then you would be given set targets or tasks to go away and achieve.' [44]
46 At the DHSS review in April 1984 SWRHA was told that it was not getting the best for patient care because it was not demanding more value for money from its districts. [45]
47 The need for the Region to change its management style filtered down to the districts promptly, with it being noted in a meeting between the Region and the B&WDHA [46] that it was the opinion of the DHSS that Regional strategy needed specific plans for achieving its objectives with the districts, rather than a mere statement of good intentions.
48 Miss Hawkins was the Chief Nursing Officer at the time of the review and had just joined the Region. She said:
` ... we were told [by the DHSS] that the Region was so laid back that it could fall off the chair ... and that is when we were told to stop being friends with the districts, in quotes, and to get to grips with them and to start making them perform well, because Region was not doing that.' [47]
49 General management was shortly to be introduced into the Region. Interviews were held in July and Miss Hawkins was appointed RGM in August 1984. The management style was changed in accordance with the Department's wishes, and services for patients generally improved (especially in mental illness and mental handicap services). [48]
Managerial relationships with the district health authorities
50 There was regular and ongoing contact between the SWRHA and the district general managers (DGMs) of all the DHAs, including the B&WDHA. Either the DGM or one of the DHA's representatives would attend meetings with the Region's Finance Officer, Planning Officer and medical officers. In addition, there would be informal contact between the DGM and the RGM, if and when requested by either party on a less regular ad hoc basis. [49]
51 The Region held annual reviews with each of the 11 DHAs within its area. This again was a chairman-to-chairman review. Each of the chief executives attended with the relevant team officers, depending on what subject was being discussed at the time. Normally the Vice-Chairman of the RHA also attended the meeting, otherwise a non-executive from the RHA who had a particular oversight of a district was present. [50]
52 A team of assistant RGMs, who had responsibility to the RGM for the individual districts, assisted the RGM. A certain amount of feedback from the DHAs would also come to the RGM on an informal basis through these assistant RGMs following meetings with the DGMs and other officers of the individual DHAs. The size of the area covered by the RHA and the number of individual departments and specialties maintained within all the hospitals in this area determined the degree of their individual scrutiny by the RGM.
53 Miss Hawkins explained in oral evidence:
` ... [the feedback from districts] would have been done on an informal network, because I did have AGMs [assistant RGMs] who were responsible for individual Districts, and that would have been done when they actually sat with them to see what should be coming up as agenda items at our reviews. I mean, cardiac surgery was a very small part, as I have tried to explain, of the total acute and other services in the Region, so it was not high on my agenda every single time I sat down with a DGM.' [51]
54 The function that the RHA could perform was limited by the authority and control it had over the districts. Miss Hawkins in her oral evidence was asked whether her role as RGM gave her the direct supervision of the 11 districts underneath the SWRHA. She replied:
`It was a very difficult system because the Regional Health Authority had monitoring and a degree of control, in italics, of its Districts without the actual authority to affect them directly, because each District had its own Chairman and non-Executive Board who actually managed the Districts.
`So it was a situation where you had accountability and responsibility without true authority.' [52]
55 Continuing on the issue of the control the Region had over the DHAs, Miss Hawkins was asked whether these reviews were of the district or with the district:
`It was a situation where, when I came into office in 1984, we were tasked by the then Minister to take control of our Districts who were perceived not to be performing as well as could be expected and that Region needed to get a grip on things.
`... I was a very strong executive and although we did not have direct control of Districts, they did feel accountable to us. That was partly style and partly the fact that I had a good team at Regional level who were in a position where they could challenge and naturally take things forward with their counterparts at District level.' [53]
56 Dr Pitman explained the position of the RGM within the RHA as follows:
`The RGM was the ... head of the officers of the RHA, but there was also a Health Authority with a Chair. The regional team of officers were the executive officers and the lay members, who may have been drawn from clinical specialties as well as from other groups, where the non-executive directors intersect. Together they form the Health Authority.
`The Regional General Manager had a number of departments with the equivalent of directors at the head of them. One of them was community medicine or public health medicine, which also included pharmacy and dental advice, and the Regional Scientific Officer, who administered the scientific equipment budget for the Region, and that was things like linear accelerators, radiotherapy, and the larger pieces of investigational equipment, some of the catheterisation equipment.' [54]
57 In addition to the departments of Community Medicine (latterly called Public Health Medicine), Capital Planning, Service Planning, Finance and Human Resources, was the Works Department, which was linked to Capital Planning. The Service Planning Department and the Finance Department were also closely affiliated. [55]
58 With respect to the Public Health Department, the RMO delegated his function by allocating responsibilities to cover different areas, depending on how many people he had in the department, to the public health consultants and also to the other professional staff. Any one particular person would not be involved with a particular area all the time, but would do some of the routine work and due to their general involvement would be the first person to be called upon if something needed to be done. It was a question of delegation by the RMO. [56]
59 The number of areas any one individual had to keep a watch on varied from year to year, depending on what the priorities were and how many other consultants there were in the department. Dr Pitman was the only consultant in the department for `substantial periods of time', at other times there were as many as three. Between them they looked after approximately 25 different specialties, not all of which would be active at the same time. Sometimes, four or five specialties would be involved in respect of the same medical discipline, such as was the case with cardiac surgery. [57]
60 The role of the RGM was mainly strategic, concerned with financial allocation and overseeing general performance, rather than the specifics of any one particular individual service, such as cardiac surgery. [58] In order to put this strategy-forming function into effect, the RHA used a committee structure.
The Regional Hospital Medical Advisory Committee (RHMAC)
61 The role of the RHMAC was to support the RHA in its strategic function. Its function was primarily reactive, responding to specific enquiries from the RHA for expert specialist knowledge. This specialist knowledge would come from the RHMAC's sub-committees, which would be commissioned to advise on a specific matter. This advice was then included in the RHMAC's reports and recommendations submitted back to the Region.
62 Prior to 1984, SWRHA had an RHMAC that dealt with a mixture of both primary and secondary services. This committee was then split, so that the secondary (hospital) services were separated from community services, allowing GPs to become more involved in the actual development of primary care. The remaining secondary hospital services side of the committee became the new RHMAC, [59] which became a key link between the RHA and the profession. [60]
`We revamped the Regional Medical Advisory Committee so that it had representatives from every District serving on it, as well as the Regional Medical Officer, and I was a member, at that time, for the decision-making meetings.
`Each time we [the Regional Health Authority] needed to look at acute or other services, then the subject was given to the Regional Hospital Medical Advisory Committee who would form a sub-committee for the specialty under review, and they would put together a strategic outline of the services that were under review. They would take it back to the main committee, who would take it to their Districts and when they signed up, it would form the strategic statement for the Region. So all Districts and all the specialty people had been involved in developing the service strategy.' [61]
64 From 1984 onwards, the RHMAC was made up of the chairmen of the various specialties' sub-committees. The membership of the RHMAC was selected from across all the districts within the RHA. The consultants' committee of each district (and later NHS trust) nominated two individuals. The chairman of the RHMAC and the RMO/RDPH then chose the committee from these nominations to ensure there was an equitable spread of specialties represented. [62] Typically there were 20 or so consultants chosen to make up the committee. Mr David McCoy noted that there was no specific consultant for cardiac surgery on the RHMAC while he was chairman. [63] From 1991 the DHAs were purchasing authorities which did not employ clinical consultants so were not represented on the RHMAC, but there was always a district public health physician in attendance who could give a DHA perspective. [64]
65 At the time of the purchaser-provider split, the constitution of the committee changed to trust-nominated medical representatives together with sub-committee chairmen attending as required or on request of the Chair. In addition, a primary care representative was also added. [65]
66 Therefore, the RHMAC membership was mainly provider-based after the split, with a minimal role being played by the DHAs. A representative from the consultants in public health medicine also sat on the RHMAC. Although accountable to the RMO in any event, this assisted the structure and communication by making the Department of Public Health in effect like another sub-committee.
67 The RHMAC produced a number of advisory statements, each of which would take a couple of months to develop. They would be worked on gradually over a number of weeks. [66] Dr Mason, in oral evidence, said:
`A major problem in drawing up the RHMAC strategic statements about services was the poor quality of the data about clinical activity. The data collected at regional level once fed back to clinicians had little credibility. Total numbers of discharges and deaths for a speciality in a hospital were reasonably accurate but: ... analysis was only by speciality and not individual consultant ...' [67]
68 The Cardiac Services Medical Advisory Sub-committee produced a document, `Cardiac Services within the South West Regional Health Authority - A Strategy for 1988/98'. [68] This was a document produced by taking advice from, amongst other sources, the RHMAC's sub-committee on cardiac surgery and cardiology. The purpose of the document was to advise the RHMAC and the RMO, and through them the RGM, as to the direction in which they felt, clinically, the Region should be moving. [69]
69 The sub-committee meetings were composed of clinicians from the relevant departments. The cardiac sub-committee meetings, for example, included cardiac surgeons, cardiologists and radiologists. It was concerned with heart disease of all types. In addition, there was the paediatric sub-committee which considered matters specific to children.
70 The cardiac service sub-committee was supported by Dr Pitman. The RHMAC strategic statement on cardiac services was published in November 1989.
71 The Chairman and the RMO/RDPH instigated all the work of the RHMAC, and the Committee responded to any requests for specific advice from the RHA or RGM. [70] The RHMAC meetings were held monthly. The discussions held were to review and advise on papers provided by the RMO/RDPH and reports provided by the sub-committees. [71] The RMO/RDPH subsequently presented the minutes of the meetings to the RHA meetings.
72 The RHMAC was purely advisory and had no executive or budgetary authority. The aim was to advise and review the present hospital situation in the Region and to advise on future new hospital developments, e.g. new buildings or departments, appointment of consultants or other hospital medical staff. [72] The advice given was generalised in nature, based on facts and figures provided by the RHA, e.g. length of waiting lists, patient throughput, and shortages in staff and facilities. The Committee had no special knowledge of the quality of the service given. [73]
73 In order to advise the RHA in its strategic planning role, the RHMAC produced 29 strategic statements about clinical specialties or services, which were published in five documents between November 1989 and July 1991. Each sub-committee produced a report to the RHMAC, supported by one of the Regional public health specialists. The RHMAC then discussed the report and prepared a summary in a standard form. This was then sent back to the sub-committee for its approval prior to being submitted to the SWRHA. [74]
74 None of the individual RHMAC statements were formally endorsed by the SWRHA at the time they were presented until December 1992, when the Regional Strategic Framework, which incorporated edited versions of the statements, was formally adopted. [75]
Other channels of communication within the Regional Health Authority
75 Miss Hawkins explained that the Regional Team Officer meetings were attended by the senior management team: the RGM, the Finance Director, the Medical Officer, the Human Resources Director, the Capital Planner and the Service Planner. [76]
76 The channels of communication within the RHA were described by Dr Pitman as follows:
`The RMO would have met regularly with the other heads of department and Catherine Hawkins, and would have relayed back information from those meetings which was relevant in his or her eyes to individuals within the department. There was not, as far as I remember, a regular meeting within the Public Health Department of everybody involved, but there would have been 1 to 1 meetings or 1 to 2 or 3 meetings at fairly regular intervals around specific topics.
`Across the Regional Health Authority there were groups called the Capital Planning Group which would look at capital investment, and the Service Planning Group, and some of the letters which you have involve some of those managers who were involved in organising those and they would have asked relevant people within public health to come for specific items or to come for the whole meeting, depending on what was being discussed.
`So there was quite a lot of horizontal communication, but most of the vertical communication, practically all of it, was through the head of department at my level.' [77]
77 Miss Hawkins described the RMO as having had oversight of the Avon districts as part of the duties assigned to them. [78] She further explained:
`The situation was, as RGM in a very big Region and a very large budget in the billions, there was no way that I could have a dialogue with DGMs or important officers on every single occasion. There was also in my mind the fact that every now and again one would have to be quite rigorous with the DGMs in order to achieve the change of style and that could be more than confrontational in the early stages and was something to try and be avoided and to come in as the reinforcer and not the enforcer.
`So I set up a system where I had four major officers at Regional level: the Finance Officer, the Human Resources Officer, the DMO and the Capital Planner. So each one of those was assigned basic responsibilities overseeing certain Districts. The RMO was assigned the Avon Districts: Frenchay, Southmead, Bristol & Weston, because Southmead and the BRI were teaching hospitals and there was a lot of University liaison and medical teaching.
`So that the RMO could be the first point of contact by a DGM who would say, "We would like to do X", or "We do not want to do Y", "What will the RHA make of it?", "What will Catherine do?", or "We have a problem up there, come back and let me know and we can get together with Catherine and the team and try and sort something out".
`So, they were the first point of contact and had the first oversight of the District: anything of importance, they were supposed to come and keep me informed, not for me to dabble in it unless they needed that assistance, but to deal with things; to prepare a District for the review, give us feedback for the departmental reviews. So the RMO had oversight of Avon.' [79]
78 So the RMO would have more direct information and would have that information sooner, before it had been filtered through to the RGM. That was, unless the matter was so serious that a DGM brought it straight to the RGM. [80] Dr Mason said that the number of consultants and the distances to be travelled in the South West made keeping in close touch difficult. [81]
79 The post of RMO/RDPH was accountable to the RGM. The major role of the RMO at Regional level was in planning matters. [82] The core responsibilities of the post were:
- ensuring that the RHA obtained the best medical advice, particularly its strategic planning role;
- ensuring the effective functioning of the district public health departments and reporting annually on the state of the public health in the Region; and
- implementing the procedures for clinical complaints against hospital doctors. [83]
80 In addition, the RMO/RDPH was also made responsible for the development of medical/clinical audit (1989-1993), the development of clinical computing and information (1988-1993), and for liaison with the Bristol districts (1988-1991). [84]
81 The RMO/RDPH had three formal mechanisms for obtaining medical views and opinions:
- He was the secretary of the RHMAC, which met monthly. It had over 20 specialist sub-committees that met periodically.
- He was also secretary of the RPCMAC, which also met monthly.
- He was also the Chairman of the Directors of Public Health Forum. [85]
82 The RMO/RDPH and these advisory committees were responsible for advising the RHMAC on what they considered should happen, and then it was the function of general management and later performance management to be responsible for ensuring that policy was carried out and the targets were achieved. [86]
83 In addition, informal medical advice came through general networking with doctors throughout the Region, [87] attending scientific meetings of particular specialty groups and visiting hospitals, particularly in respect of implementation of proposals concerning junior doctors' hours and quality of care initiatives. [88]
84 Until the trusts were set up in April 1991, the RMO was responsible to the RGM for liaison with the three Bristol health districts. This involved, where possible, a quarterly contact with the DGMs and assistance to the RGM in preparation of the annual review of the districts' performance. [89]
85 Dr Mason noted that this approach worked well with Frenchay and Southmead, but he was not able to meet Dr John Roylance, [90] District General Manager of the B&WDHA from 1985, as often as he would have liked. [91] He explained that Dr Roylance preferred to deal with general managers rather than medical advisors. If he had any major issue he would discuss it with the RGM direct. Dr Mason said that he did not press for meetings, knowing that Dr Roylance was reluctant and that Dr Roylance communicated regularly with Miss Hawkins. [92]
86 Miss Hawkins had frequent informal meetings with Dr Roylance. This was facilitated by the proximity of the two organisations:
` ... he and I met informally on several occasions .... The Region was in Kings Square House. The BRI was literally 100 yards away.' [93]
87 The powers that the RHA had previously exercised also changed in other ways once trust status was conferred on the UBHT:
` ... the control of trusts went directly to the Department, so Region was not involved. Region continued to oversee the non-trust units and the Department had a section which managed or had direct contact with trust status units.' [94]
`In the early 1990s the role of the Regional Health Authority in the trusts was diminishing with the setting up of Department of Health Regional Outposts for the performance management of trusts directly responsible to the Department of Health.' [95]
89 The SWRHA merged with part of the old Wessex Region in 1994, almost doubling the population it covered to six million. This was now the S&WRHA. The employees from both regional authorities were `slotted in' with each other. [96]
90 From 1 April 1996 the S&WRHA was abolished, and the South and West Regional Office of the NHS Executive was created. [97]
91 The role of the regional office of the NHS Executive (NHSE) was different from that of the old RHA. It was staffed by civil servants who were ultimately responsible, via a number of tiers of management, to the Secretary of State. [98]
92 The setting up of regional outposts of the NHSME was announced in January 1992, and they became active from 1 April 1992. [99] Their function was to performance-manage the trusts, being separate from the health authorities and directly responsible to the Secretary of State. The regional outposts were established `in order to carry out financial monitoring and to undertake appraisal of strategic capital investment on behalf of the NHS Management Executive to whom the NHS Trusts reported'. Also, according to Roger Hoyle [100], it was to `co-ordinate with Regional Health Authorities and the Management Executive proposals for capital investment by Trusts through the use of commercial-type investment appraisal.' The liaison between the regional outposts and the RHA was seen as having a fairly low profile as far as Dr Pitman (and others) was concerned, because they contained no medical advisory staff. Their boundaries were not the same as the Region, but the regional outpost that the SWRHA dealt with was the one based in Bristol. [101] The regional outposts were abolished in 1996 and their performance-monitoring function was absorbed into the NHSME regional offices.
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Footnotes
[26] Southmead, Frenchay and Weston Hospitals were separate districts within Avon Health Authority (Teaching)
[29] T56 p.19 Miss Hawkins. The Isles of Scilly were added in 1981
[30] WIT 0317 0002 Dr Pitman
[31] WIT 0317 0003 Dr Pitman
[32] WIT 0119 0001 Mr Wilson
[33] T58 p.5 Dr Pitman. Office held by Dr Martin RF Reynolds, then Dr Marie J Freeman, then Dr A Mason; the title of RMO changed to RDPH at about the time community medicine became public health medicine, in about the middle of the period of the Inquiry's Terms of Reference
[34] WIT 0317 0003 Dr Pitman
[35] The RHMAC is dealt with further below, see paras 61-74
[36] WIT 0317 0003 Dr Pitman
[37] WIT 0317 0004 Dr Pitman
[38] Dr Alistair Mason, RMO/RDPH from April 1988 to June 1994
[39] WIT 0399 0044 Dr Mason
[40] WIT 0317 0004 Dr Pitman
[41] WIT 0317 0004 - 0005 Dr Pitman
[46] UBHT 0102 0433; notes of a meeting between SWRHA and B&WDHA on 11 June 1984
[62] WIT 0399 0044 Dr Mason
[63] WIT 0436 0001; Mr McCoy was chairman of the RHMAC from 1990 to March 1994
[64] WIT 0399 0044 Dr Mason
[67] WIT 0399 0003 Dr Mason
[68] UBHT 0156 0255; `Cardiac Services within the South West Regional Health Authority - A Strategy for 1988/98' , 29 September 1988
[70] WIT 0399 0044 Dr Mason
[71] WIT 0436 0001 Mr McCoy
[72] WIT 0436 0001 - 0002 Mr McCoy
[73] WIT 0436 0002 Mr McCoy
[74] WIT 0399 0002 Dr Mason
[75] WIT 0399 0002 Dr Mason
[78] WIT 0091 0001 Miss Hawkins
[79] T56 p.118-19 Miss Hawkins
[81] WIT 0399 0044 Dr Mason
[82] WIT 0399 0044 Dr Mason
[83] WIT 0399 0001 Dr Mason
[84] WIT 0399 0001 Dr Mason
[85] WIT 0399 0001 Dr Mason
[86] WIT 0399 0043 Dr Mason
[87] WIT 0399 0001 Dr Mason
[88] WIT 0399 0043 Dr Mason
[89] WIT 0399 0003 Dr Mason
[90] Dr Roylance was appointed DGM of B&WDHA from 1 February 1985 and held the office until 31 March 1991. On 1 April 1991 he became Chief Executive of UBHT, until his retirement on 21 October 1995
[91] WIT 0399 0003 Dr Mason
[92] WIT 0399 0046 Dr Mason
[95] WIT 0317 0004 Dr Pitman
[99] Edwards B. `The National Health Service 1946-1994: A Manager's Tale' (1995), Nuffield Provincial Hospitals Trust
[100] WIT 0497 0001; Roger Hoyle was the Executive Director of the Regional Outpost of the NHS Management Executive responsible for monitoring NHS trusts in the former South Western and Wessex Regional Health Authority areas, from 1 April 1990 to June 1994