Are strategic health authorities staring into the abyss?

At Labour’s conference in Brighton health minister Mike O’Brien called on SHAs to justify their existence, contrasting the high salaries paid to the chairs and chief executives with their variable performance on objectives such as spreading innovation.

Mr O’Brien’s broadside means SHAs are short of friends among both main parties

Two years ago Windmill - a simulation exercise on the long term health economy run by the King’s Fund and others - struggled to define a clear role for SHAs in a future with a more open market for healthcare provision.

Then, back in reality, world class commissioning and Lord Darzi’s next stage review gave SHAs new focus in 2008. Ministers were determined not to be accused of drawing up a national blueprint remote from local realities, so the Darzi review became the summation of regional plans drawn up by the SHAs, while the gap between world class ambition and real world performance promised a long life for SHAs as overseers of primary care trust development.

SHAs were central to getting health policy back on track - providing a mechanism for the Department of Health to loosen its grip a little, encouraging the re-engagement of clinicians in policy, providing a regional improvement strategy and pushing quality centre stage.

In the last few months the regional tier has again been in the thick of the NHS policy action, taking a leading role in the drive to spread innovation and supporting moves to improve the quality of NHS leadership.

But belief in the value of SHAs has been dented by the Mid Staffordshire Foundation Trust scandal, when NHS West Midlands did not spot the critical deterioration in services. Confidence has ebbed just as the health service is trying to save money and more than half of the country’s trusts have broken free of SHA control as foundation trusts.

Mr O’Brien’s broadside means SHAs are short of friends among both main parties. He ruled out abolition, but at the same conference fringe meeting former health secretary Alan Milburn, still burning with reformist zeal, was not so squeamish.

The Tories have promised they would not impose another round of restructuring, but if a Conservative government sets up an independent NHS management board it could let that swing the axe - to cut back the “bloated bureaucracy” as the party calls it - while leaving the politicians’ hands clean.