this week

A 'radical new agenda' for health authorities will be set out in guidance from health minister John Denham, due to be published today.

Leadership for Health warns against a drive to merge HAs once functions have been devolved to primary care groups and, from April next year, free- standing primary care trusts.

Mr Denham says: 'Reorganising the HA map is not the pressing priority. There is no central drive to merge HAs.'

NHS Confederation chief executive Stephen Thornton welcomed the move away from 'merger mania'.

But Manchester HA chief executive Neil Goodwin said: 'I don't believe that you can introduce PCGs and PCTs, devolve a substantial number of responsibilities, leave HAs with a strategic role and have the same number of HAs.'

The document does back formal partnerships between HAs, agreed with regional offices, to tackle sub-regional problems.

It says HAs will play a key role in managing the local health economy, including PCGs and PCTs. They will also be responsible for taking 'tough decisions about what really are the priorities, what the evidence says, what can be afforded and what can be delivered'.

While PCGs and PCTs will develop and provide primary and community care, HAs will take control by 'securing agreement to the health improvement programme and ensuring that it is delivered'.

HAs will be judged by a new HImP performance programme that will award beacon status to the best HImPs.

HAs will control access to development funds, and arrange for savings and overspends to be shared between PCGs and PCTs.

They will also play a 'key role in driving the process' of reorganising local services, managing the process and 'securing ownership' from stakeholders.

HAs are warned not to 'hold back' potential PCTs. They must be 'mature enough to manage a mixed economy' of PCGs and PCTs.

HA chief executives and PCGs welcomed the guidance, but demanded new money to make it work.

Mr Thornton said the document 'recognises that HAs have a very important role to play' in providing 'strong local leadership'. But he said funding 'now needs to be addressed', asking: 'How is all this going to be resourced?'

He pointed out that many skilled and talented staff have already left HAs and moved to PCGs and PCTs.

Dr Ian Greatorex, chief executive of Salford and Trafford HA, said: 'With continuing constraints on management costs we will have to find new ways of delivering these targets, such as team-building, pooling funds and lead commissioning.'

National Association of Primary Care chair Dr Rhidian Morris said the guidance outlined 'an ambitious agenda', with HAs taking on the role of 'facilitator, supporter, broker of funds and holder to account'.

Ministers were signalling that HAs would be 'the local agents of the health secretary', he said.

Many HA senior managers welcomed the document as proof that ministers had listened to them.

Dr Greatorex said the guidance was 'compatible with what a lot of HAs are already doing'. It would give HAs a new responsibility 'across the whole health system'.

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