The Proposal: Abolish SHAs?
Civitas, 5 October 2009
As prescriptions for NHS cost-cutting abound, health minister Mike O’Brien has proposed a somewhat radical question: do we really need strategic health authorities?
At a Labour Party conference fringe event last week, O’Brien called upon strategic health authority (SHA) chief executives to justify the organisations’ existence and suggested that a greater percentage of their budgets should be devolved to commissioners.
Currently, England’s ten SHAs oversee DH policy on a regional level. They are responsible for building capacity and creating frameworks for the local development of health services, and contribute to the performance monitoring of NHS commissioners and provider organisations in their regions.
SHAs were created in 2002 in order to locally manage the NHS. While there were originally 28, this number was reduced to ten in 2006 with the intention of delivering stronger commissioning functions and therefore improved services for patients and better value for money for the taxpayer. But if 28 authorities were deemed too many to efficiently monitor and support local care purchasing, how would the existing 152 PCTs fare on their own? Or would we see the creation of yet another arm’s length regulatory body to take on the responsibility?
SHAs collect data and make important public health decisions for regions larger than those covered by PCTs–for example, whether or not to fluoridate drinking water–and a few have implemented successful, region-wide initiatives that would have been much more difficult, if not impossible, for PCTs to collaboratively create on their own—such as Northwest SHA’s Advancing Quality programme.
On the other hand, getting rid of strategic health authorities would potentially save the health service hundreds of millions of pounds annually and remove a major tier of NHS bureaucracy. In doing so, could it possibly allow for quicker innovation through increased freedom among PCTs and providers (both of which are already monitored by the Care Quality Commission, Audit Commission and other bodies)? I’m interested to hear what others think about this… do we need SHAs?
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Part of the problem in delivering patient services that are responsive to local needs is multiple layers of bureaucracy. We need to re-visit the original concept of primary care, which is Local services which are acceptable,accessible, affordable and tailored to local needs.
Regulatory bodies need to be lean and their roles acutely defined.The place to spend most of the money is where there is direct impact on patient care.
Hi Peter,
I completely agree on the use of management consultancies! I’ve been talking to some people this week about SHAs, and another idea that has come up is to instead give them more authority over the commissioning process…a bit like the old HAs. I hadn’t thought of that and may write more on it later…
Laura:
As a practising GP I would not notice any problem either for me or my patients if the “local” SHA disappeared.
Abolishing them could save us a lot of money that currently is not buying much healthcare for patients.
I’d apply similar logic to management consultancy in the NHS