Strategic health authorities have been warned not to “guard the borders” if they want to get the most out of their assurance process.

NHS chief executive David Nicholson said the assessments were “not a clever mechanism to catch people out” but “genuinely an attempt to make them the best they can possibly be”.

In an interview with HSJ following a pilot of the assurance process in the South Central region, Mr Nicholson said the Department of Health was planning one SHA visit per month, probably starting in September. The first will be East of England.

Mr Nicholson said the recession was one of several factors that changed the context. “Part of the reason for doing it is that the SHAs’ responsibilities are changing as we speak,” he said.

The process is meant to provide assurance of SHAs’ performance combined with developmental feedback so they improve further (see box).

For the pilot, the assurance panel that visited NHS South Central included several DH director generals, Hertfordshire county council chief executive Caroline Tapster and NHS East of England chief executive Sir Neil McKay.

They collected information and then tested their theories about the way the organisation and system functioned in meetings with NHS staff locally.

Discussions with SHA staff preceded a “panel to board” meeting, in which the panel raised “the four or five key issues about the way in which their organisational system worked and how they needed to get themselves in the right place”, Mr Nicholson said.

“The upshot is an exchange of letters between ourselves and the SHA setting out how we think they have done and what are the things that need to be worked on over the next period.”

In South Central’s case, the SHA was “strong” on performance and finance but the panel found “real weaknesses” in relation to workforce planning. He said the SHA acknowledged these.

South Central chief executive Jim Easton told HSJ he had found the process “helpful” and that having the departmental team visit for three days was a “fantastic opportunity, not just for the SHA, but for the whole patch”.

He said he was “impressed with how they set a really powerful mix of challenge and support” and advised other SHAs to welcome the process.

SHA assessments

  • Performance
  • Delivery of statutory duties
  • The “health” of the organisation
  • The “health” of the regional system - how well NHS organisations are working with local government, particularly social care, and the private sector