A history of the intermediate tier in the English NHS : Centre, region, periphery

AbstractCentre‐periphery relations have constituted a paradox for the English National Health Service (NHS) since its creation in 1948. Is it a top‐down national service organised locally, or a bottom‐up arrangement of local health systems managed nationally? North West England provides a regional case study which traces the changing organisational, relational and spatial dimensions of the intermediate tier. These reposition centre‐periphery tensions. In foregrounding, situating and conceptualising region in these terms, I offer new insight into existing narratives and centre‐periphery relations in the NHS.