ABSTRACT
The organisational structure of the state's involvement in health care has been the subject of conflict at least since the introduction of National Health Insurance (NHI) in 1911. With the establishment of the National Health Service (NHS), it became a major focus for political debate in which a considerable degree of political consensus around the general case for reform dissolved into conflicting views about the details of the reform, especially the organisational details. The outcome, as virtually all commentators seem to agree, was a political compromise in the form of the so-called tripartite organisational structure of the NHS. This 'irrational administration' was problematic at all levels of health care delivery and not just in London. Organisational problems were recognised by the Guillebaud Committee especially with regard to services for elderly people and the maternity services. The organisational structuring of the state's involvement in health care had been the subject of conflict at least since the introduction of NHI.
