In 1982 the 8 Area Health Authorities in Wales became 9 District Health Authorities (DHAs). The majority of the new DHAs had the same boundaries as county councils and the Family Practitioner Committees. District Management Teams were replaced with a system of unit management.
The 1980s also saw the introduction of General Management to replace the previous system of consensus management. This was outlined in the Griffiths Report of 1983. This report recommended the appointment of general managers with whom individual responsibility and accountability lay at all levels of the NHS. The report also recommended that clinicians be better involved in management processes.
In Wales during the 1980s particular developments in fields of public health and health promotion emerged. The Welsh Health Promotion Authority launched, in 1985, ‘Heartbeat Wales’ which sought to reduce the level of heart disease across the principality. In 1989 the Welsh Health Planning Forum published the ‘Strategic Intent and Direction for the NHS in Wales’ which pioneered the concept of ‘health gain’. Wales also took the lead in the 1980s with strategies for mental illness and mental handicap (learning disabilities).
Financial pressures continued to place significant strain on the NHS. In 1987 an additional £101 million was provided by the government to the NHS. In 1988 the then Prime Minister, Margaret Thatcher, announced a review of the NHS. From this review and in 1989 two white papers Working for Patients and Caring for People were produced. These papers outlined the introduction of what was termed the ‘internal market’ which was to shape the structure and organisation of health services for most of the next decade.