Annex A > Chapter 6 - Funding and Resources > Management of funding by the District prior to 1991
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Management of funding by the District prior to 1991
32 From the beginning of the period of the Inquiry's Terms of Reference, the general manager of a district health authority was accountable for the financial performance of the district. [51] Dr John Roylance became District General Manager of B&WDHA in 1985 and retained this position until April 1991, when he became Chief Executive of the UBHT. General managers were encouraged to delegate budgetary control. All health authorities, including B&WDHA, were able to determine for themselves to what level budgets should be delegated and what flexibility individual budget-holders were to be given. [52]
33 Until the formation of the UBHT, the acute services of the B&WDHA were managed through two units: the Central Unit and the South Unit. Mr John Watson was the Unit General Manager of the Central Unit, which included the BRI and the BRHSC. Mrs Margaret Maisey was the General Manager of the South Unit. [53]
34 The structure of the management units within the District is summarised in Figure 1:
Figure 1: The structure of the Bristol & Weston Health District Authority and its units, 1984-1991
35 Both the Central Unit and the South Unit had designated financial managers, supported by a qualified accountant and a financial team. [54]
36 The B&WDHA's budget statement for 1984/85 stated that it was a prime aim of the recent restructuring of the NHS [55] that decision-making be devolved to the operational level. An essential feature of this delegation was the devolving of budgets from district level to units, for which the responsible unit managers (administrator, nurse and doctor) would be accountable. Acting together, they should be able to manage services in the unit within service and budgetary objectives agreed with the district management team. [56]
37 The 1984/85 budget statement continued:
`Responsibility for managing budgets on a day to day basis rests with the budget holder. This will be an individual responsibility for District managed services but within units will be both an individual responsibility of each budget manager with a collective responsibility placed on the Unit Management Group ...'
`The further delegation of budgets for 1984/85 is entirely consistent with the devolution of decision making and accountability to unit level. However, the Chief Nursing Officer, District Works Officer and other officers with District-wide responsibilities have a legitimate wider interest over the respective total budgets for their service and are to be consulted when annual budgets are determined.' [57]
38 The senior finance officers from the District Health Authority's finance department, as Unit finance officers, had a general responsibility for providing financial advice to the Unit Management Group. This included assisting in the compilation of annual budgets and reporting regularly to the Unit Management Group on budgetary performance, together with consideration of the financial implications of changes in the pattern of service being provided, the pursuit of efficiencies and the implementation of cost improvement programmes. [58]
39 Mr Nix stated that, although the principal financial accountability to the District Health Authority was through Mr Watson and Mrs Maisey, the actual day-to-day responsibility for financial management was at ward or department level. [59]
40 The Regional policy in respect of capital allocations is discussed by Mr Bevan in his paper, `National and Regional Resource Allocation Frameworks and Funding Availability for Acute Sector Health Services at Bristol' (see Annex B). The methods used followed national methods of capital allocation. [60] In 1984/85, 85% of capital resources were allocated by the Regional Health Authority to the districts within the Region on the basis of projected populations, weighted by the use of services according to age and gender, and by morbidity. The remaining 15% was distributed in relation to the replacement value of the existing capital stock, weighted according to the age of the asset. This situation was recognised as being inequitable and it was planned to phase it out over the ensuing seven years. [61]
41 According to the B&WDHA Budget Books, the following capital allocations were made by the authority (see Table 2):
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Footnotes
[51] UBHT 0099 0087; DHSS Health Circular `Financial Directions for Health Authorities in England' HC(84)20: effective from the date of the General Manager's appointment
[52] See, again, the Circular HC(84)20, UBHT 0099 0089: `Each General Manager should be able to delegate responsibility for a budget or part of a budget to an individual officer who should be responsible for the activities provided for within that budget and/or the supply of information to the Treasurer to assist budget making and monitoring'
[53] WIT 0106 0012 Mr Nix
[54] WIT 0106 0185 Mr Nix
[55] The Budget referred to changes which took place in 1982
[56] UBHT 0339 0061; B&WDHA Budget
[57] UBHT 0339 0062; B&WDHA Budget
[58] UBHT 0339 0062; B&WDHA Budget
[59] WIT 0106 0181 Mr Nix
[61] UBHT 0339 0180; B&WDHA Budget