NHS chief executive Sir David Nicholson has told NHS North West to adopt a more “proactive approach” to improving performance across the region.

The recommendation was made to the strategic health authority’s chair Sir David Henshaw in a letter accompanying a Department of Health report on findings from the inaugural SHA assurance process.

As the economic climate changes it will increasingly become the responsibility of the SHA to take decisions

Sir David Nicholson

NHS North West was visited by a panel of senior DH representatives last October, including Sir David and director general of NHS finance, performance and operations David Flory.

Although Sir David praised the SHA for “strong leadership” on quality improvement and their “comprehensive approach” to commissioner development, he said they have “tended to adopt a reactive approach” to addressing performance issues.

He recommended the SHA implement “systematic early identification and intervention processes”, and use “defined milestones for monitoring recovery and improvement” across the region.

Sir David also said there was “lack of clarity” in the SHA’s approach to dealing with conflict which he said needed managing “more effectively”.

“When conflict arises in the system, for example around the configuration of services, it is not always effectively dealt with by the SHA,” he said. “As the economic climate changes it will increasingly become the responsibility of the SHA to take decisions - including those that may be difficult or unpopular for the system as a whole - and to mange any resulting conflict.”

A spokesperson for NHS North West said the SHA welcomed the report for “highlighting the areas which need to be developed going forward.”

She added that the document will be presented to the SHA board “at the earliest opportunity”.

NHS South East Coast and NHS South West have also received letters from Sir David Nicholson following the assurance process. Both were told they needed to improve their “sub regional structures” to improve service delivery.