Strategic health authorities will struggle to do their jobs properly because of ‘draconian’ staff cuts, union Managers in Partnership has warned.
HSJ can reveal that SHAs have lost over half of their workforce since last year.
Figures obtained by HSJ show that following last July’s mergers, where 28 SHAs became 10, the total number of employees has been stripped from 3,617 to just under 1,600.
The massive drop has been interpreted as reflecting the weakening role of SHAs, as foundation trusts and primary care trusts grow and become more autonomous.
The region that has seen the biggest losses is London, which employs 130 staff compared with the 730 that worked for the five former authorities.
Managers in Partnership national officer Jim Keegan said: ‘The cuts have been draconian. We’re really fearful of SHAs’ capacity to deliver with such a small number of staff.
‘They will say that a lot of the work will go to primary care trusts but we’re not convinced that PCTs have either the capacity or desire to take that on.’
Senior fellow at the King’s Fund Professor Richard Lewis shared some of these concerns.
‘PCT capability needs to be widely improved. The risk is that we reduce the size of SHAs prior to fully developing PCTs.’
However he said he still saw SHAs as having a significant part to play by supporting trusts facing the biggest problems.
‘They’re not obsolete but the role is changing,’ he said.
Professor David Hunter, head of Durham University’s centre for public policy and health, said a smaller workforce was leading to a more ‘hands off’ approach by SHAs.
‘There isn’t the capacity to meddle or interfere as much as there used to be, simply because there are fewer bodies around to justify their existence,’ he said.
‘Some people would argue that they may wither away having built up the other organisations.
‘At the moment, PCTs are still in the shadow of SHAs but the power balance will shift.’
Professor Lewis said he saw SHAs’ future as feeding into wider regional development and regeneration initiatives rather than playing any practical role in running the NHS.
Most SHAs, when contacted by HSJ, said much of their work had been devolved to primary and secondary care, and demonstrated reduced management costs as a result of the job cuts.
NHS West Midlands saved£7.5m after axing 196 staff, while NHS South East Coast has made a 40 per cent reduction in management costs, which is being reinvested in frontline services.
NHS North West chief executive Mike Farrer said in future the new organisations would spend less time with trusts.
‘It’s about making sure that there is a degree of competition in the system and maintaining standards,’ he said.
Much of SHAs’ work is no longer day-to-day performance management, but working with commissioners, he added.
Acting director of the Office of SHAs Linda Hutchinson said there would always be a need for an intermediate NHS tier between government and trusts.
‘We recognise that the SHA role has changed and will continue to change,’ she said.’
NHS Confederation policy director Nigel Edwards added: ‘There needs to be people who can hold to account, oversee the strategy, broker solutions and problems and some functions beyond that. Trusts should be self-governing.’
Staff losses by strategic health authority
SHA Number of staff Number of staff before merger after merger
London 730 130
North West 500 178
East Midlands 350 134
South West 463 221
North East 172 82
West Midlands 322 126
South East Coast 192 153
South Central 243 191
East of England 313 145
Yorkshire & the Humber 332 232
Total 3,617 1,592