'The greatest concern is that SHA shrinkage is outstripping the growth in capacity and expertise among PCTs'

The steep fall in strategic health authority staff vividly illustrates the pace and scale of change in the health service.

The drop in SHA staff is certainly dramatic - roughly half the pre-merger posts have gone, leaving around 1,500.

The attack over staffing levels launched by the union Managers in Partnership brings into focus the intense debate over the authorities' role - and even whether they have a long-term future.

Apart from the obvious economies of scale in slashing the number of SHAs, the staff cuts have been driven by the push to reduce central control and encourage local innovation.

To this end SHAs have been encouraged to become leaner organ-isations less concerned with micro-management - although the rhetoric of devolution far outstrips progress to date.

Over the next year or so the move to foundation trusts will shift substantially the balance of power in the regions, a trend that will accelerate as the newly empowered trusts grow in confidence, expertise and entrepreneurship.

Meanwhile the Department of Health's plans to give primary care trusts greater autonomy if they are delivering on the emerging concept of 'world-class commissioning' further encourages those who believe SHAs face more contraction.

Notwithstanding the impact on jobs, the broad thrust of central bodies being lean and strategic rather than sprawling and meddling should be welcomed. In terms of any adverse impact on services the greatest concern is that SHA shrinkage is outstripping the growth in capacity and expertise among PCTs.

As to the future, there appears to be broad consensus that SHAs will reduce their emphasis on performance management, but will still have a role in the dynamics of the local health economy - ensuring fair competition and maintaining standards - as well as supporting trusts in difficulty.

But long term it is questionable whether SHAs will need to remain autonomous bodies.

Some even speculate that SHA functions could be subsumed by the government regional offices.

It is not immediately apparent why such a profound change would appeal to the NHS leadership, but in future years closer integration with other arms of central and local government on issues such as public health and health inequalities could see this emerging as a rational move.