The role of strategic health authorities

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Strategic health authorities (SHAs) were first suggested in the government document Shifting the balance of power. SHAs are not large organisations with around 50 members of staff each at the moment and with a budget of around £4m covering a population of between 1.1-2.5m. The boundaries of the SHAs broadly correspond to clinical networks, such as those for cancer services, lining up alongside local authority and government office boundaries.

Each SHA’s initial consultation document should provide invaluable information to local NHS influencers in their attempts to assess whether or not these new organisations are going to be important to them. These documents are easily accessible from the DH’s shifting the balance of power website section. There you will find details of what PCTs are in each SHA.

Within SHAs it is highly likely that there will be some new customers of great interest to NHS influencers. SHAs will have a key role in performance-managing the implementation of NICE guidance and NSFs, and examination of the organisational structures of SHAs would suggest that directors of public health, prescribing leads and NSF policy leads would be among this new customer group. The other key must-read document for NHS influencers is the original SHA franchise plan, a business plan for the years 2002-05.

Primary care trusts versus strategic health authorities

NHS Alliance chairman Dr Michael Dixon has called for the same structure to be incorporated within SHAs as in PCTs — ie, a clinical executive.

‘Above the level of PCT is a zone, occupied by strategic health authorities and the Department of Health, which is pretty threadbare when it comes to primary care clinicians. It’s as if they have signs on their doors that say “primary care — keep out”. If PCTs have a clinical executive that directs strategic thinking, then why not strategic health authorities? Isn’t it ludicrous that the NHS excludes clinicians from its decision-making process at every level except for primary care trusts? It is time that was changed.’

— Dr Dixon at the annual conference of the NHS Alliance in October 2004