Strategic health authorities will be abolished by 2012, throwing the job security of over 3,000 staff in doubt.
HSJ.co.uk broke the news on Monday after the Department of Health told SHA chiefs there was no place for them in the new government’s plans to manage commissioning through an independent NHS board. Providers will be overseen by an expanded Monitor, which the DH says will become an economic regulator.
A “Q&A” document circulated by the DH among SHAs on Tuesday stated bluntly: “Subject to legislation, the NHS commissioning board will become fully operational from April 2012, removing the need for separate statutory strategic health authorities”.
Details of that legislation were signalled in the Queen’s Speech the same day. The speech itself made only scant reference to legislation that would strengthen “the voice of patients and the role of doctors… to improve public health alongside actions to reduce health inequalities”.
But a statement issued by Number 10 explained that this would entail establishing an independent NHS board “to allocate resources and provide commissioning guidance, and to allow GPs to commission services on behalf of their patients”.
SHA sources have told HSJ they will now start “winding down” their activities. A DH spokeswoman said SHAs have statutory responsibilities set out in the 2006 Health Act which they will continue to discharge until “other arrangements” are put in place.
The move by new health secretary Andrew Lansley comes despite his pre-election reassurances that there would be no “top-down” reorganisation in the NHS.
The Programme for Government document published last week by the coalition inserted a caveat into that reassurance, applying it only to reorganisations that “have got in the way of patient care”.
A DH spokeswoman told HSJ the new independent board would “combine functions currently provided by the DH and SHAs, and deliver those in a much more streamlined way”.
Senior SHA staff are uncertain of the impact the change will have on them, with many hoping they will find roles in new “regional divisions” or “offices” of the independent board.
Others are also hoping to find positions in an expanded Monitor, or alternatively in practice-based commissioning consortia, which they predict will be formed through a merger of existing consortia and primary care trusts. That will be fuelled in part by the 30 per cent management cost reduction target applied to SHAs and PCTs.
According to the latest workforce statistics published by The NHS Information Centre, that could mean 3,713 non-clinical SHA staff competing with some 155,533 non-clinical PCT staff for the same jobs in new organisations.
The government has said patients will be given a “stronger voice” through “directly elected individuals” on the boards of PCTs - the process for which will be set out in an imminent white paper.
The Programme for Government document said the remainder of PCT boards would be appointed by local authorities, with the chief executive and “principal officers” appointed by the health secretary.
The document also confirmed the government plans to make GPs the lead commissioners of NHS care, with PCTs taking responsibility for public health and “residual services that are best undertaken at a wider level rather than directly by GPs”.
He said: “Somewhere in the system there will have to be accountability for what they deliver. Someone’s going to have to manage that relationship.”
Mr Stout also questioned how the arrangement would work in areas with two-tier authorities, and whether all local authorities in a patch would be granted a seat on the board, even where there were four or five of them.
He said: “Board power is being severely reduced here. One of the key powers is being able to appoint and that seems to be a power being taken away to the secretary of state and an independent management board. It does involve quite a loss of freedom for boards.”
He added there needed to be incentives to retain key players for the two years until the SHAs were phased out, asking: “What’s to stop the best in the SHA from looking for their future and jumping ship?”
Total staff employed by SHAs (headcount includes clinical staff)
North East 243
North West 470
Yorkshire and Humber 444
East Midlands 401
West Midlands 379
East of England 414
South East Coast 393
South Central 388
South West 281
Source: NHS Information Centre, September 2009