Strategic health authorities (SHA) were part of the structure of the
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementing health policy as required by the
Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
at a regional level.
History
In 2002, the existing
regional health authorities were renamed and merged to form 28 new strategic health authorities, under the National Health Service Reform and Health Care Professions Act 2002. This was the first time that the regional tier in the NHS reported directly to the centre rather than having a board and non-executive members.
The SHA chief executives were appointed after a wide-ranging search and selection process and did not represent continuity with the previous regions, not least because CEOs were allocated to areas they were not generally familiar with. A number of the new CEOs had previously been health authority CEOs or CEOs of large trusts, rather than being on the traditional path.
The role of the SHAs was set out in ''Shifting the Balance of Power within the NHS – Securing Delivery'' and included the following:
The goal was to create a coherent strategic framework for the development of services across the full range of local NHS organisations, including:
* Performance management
* Brokering solutions where there were disputes
* Building capacity and supporting performance improvement
* Preparing and delivering cohesive strategies for capital investment
* Working with workforce confederations (in some unspecified way)
* Ensuring effective professional leadership across their area.
Evolution
A pivotal event seems to have been a loss of financial control in 2005/6 and a failure of the management system to respond quickly or firmly enough. This, combined with some ministerial ambivalence about the effectiveness of SHAs and a promise in the 2005 election to reduce NHS management spending, led to
Patricia Hewitt
Patricia Hope Hewitt (born 2 December 1948) is an Australian-born British government adviser and former politician who served as Secretary of State for Health from 2005 to 2007. A member of the Labour Party, she previously served as Secretar ...
,
Secretary of State for Health
The secretary of state for health and social care, also referred to as the health secretary, is a secretary of state in the Government of the United Kingdom, responsible for the work of the Department of Health and Social Care. The incumbent ...
to announce that, following an NHS consultation which ended in March 2006, the SHAs were to be reorganized. They were reduced to ten in number by the Strategic Health Authorities (Establishment and Abolition) (England) Order 2006, as amended, and this was expected to produce substantial financial savings.
At the same time there were other important changes that had implications for the functioning of SHAs:
* Span of control – the number of PCTs was reduced to 152 from 302 in 2002 (although there had been a continuous process of mergers). At the same time, an increasing number of providers were achieving
foundation trust
A foundation trust is a semi-autonomous organisational unit within the National Health Service in England. They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local s ...
status. Both of these changed the nature of the relationships of the intermediate layer to local organisations.
* Reporting relationships – the role of CEO of the NHS and Permanent Secretary of the DH were separated and the reporting relationship for SHA CEOs moved to directly report to the NHS CEO.
* Top team changes – the top management team was reduced in size from over 50 during the early part of the period to a much more manageable number, and this was accompanied by the development of procedures to reduce the traffic of policies, instructions and requests for information to the service from the centre.
The period from 2006 saw financial control being restored and key targets were generally achieved. However, further questions about the effectiveness of SHAs and the regulatory process more generally were raised by the 2008
scandal at Mid Staffordshire Hospitals Foundation Trust.
During 2009, SHAs were subject to an assurance process to examine their performance, role in developing their systems and to give developmental feedback.
David Nicholson, NHS Chief Executive, said that the recession was one of several factors that had changed the context: "Part of the reason for doing it is that the SHAs' responsibilities are changing as we speak", he said at the time.
SHAs in this period were expected to develop a more directly strategic approach than was the case in the earlier period, following the launch of Lord Darzi's 'Next Stage Review' report in 2008. There were some examples of successful strategic changes being introduced e.g. the implementation of
trauma networks, the redesign of stroke services in London, and changes to the shape of services in Manchester, But many strategic issues remained unresolved. This was not helped by the period having an election followed by the introduction of stricter controls on reconfiguration by the incoming government and then an almost two-year period of uncertainty when the government announced its intention to abolish SHAs in May 2010. This led to SHAs being 'clustered' from ten to four in October 2011.
Abolition
Strategic health authorities and
primary care trusts were abolished on 31 March 2013 as part of the
Health and Social Care Act 2012
The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.'' BMJ'', 2011; 342:d408Dr Lansley's M ...
. Facilities owned by SHAs were transferred to
NHS Property Services, and their public health functions to
Public Health England
Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...
.
Role
Each SHA area contained various
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s which took responsibility for running or commissioning local NHS services, and the SHA was responsible for strategic supervision of these services. The types of trust included:
*
Hospital trust
A hospital trust, also known as an acute trust, is an NHS trust that provides secondary health services within the English National Health Service and, until they were abolished, in NHS Wales. Hospital trusts were commissioned to provide these s ...
*
Ambulance services trust
An ambulance services trust or ambulance trust is an organisation which provide ambulance services within the National Health Services of England and Wales. There are currently 11 ambulance services trusts in England and Wales. Ambulance services ...
*
NHS care trust
*
Mental health trust
A mental health trust provides health and social care services for people with mental health disorders in England.
There are 54 mental health trusts. They are commissioned and funded by clinical commissioning groups.
Patients usually access t ...
*
NHS primary care trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
(PCT)
The SHAs had the
board and
governance
Governance is the process of interactions through the laws, norms, power or language of an organized society over a social system ( family, tribe, formal or informal organization, a territory or across territories). It is done by the gove ...
structures common to all
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s.
After 1 July 2006
The ten SHAs established on 1 July 2006, and abolished on 31 March 2013, were:
#
NHS East of England (
East of England region)
#NHS East Midlands (
East Midlands region)
#
NHS London
NHS London (or "London Strategic Health Authority") was a strategic health authority of the National Health Service in England. It operated in the London region, which is coterminous with the local government office region. The authority closed a ...
(
London
London is the capital and List of urban areas in the United Kingdom, largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary dow ...
)
#NHS North East (
North East region)
#
NHS North West
NHS North West was a strategic health authority (SHA) of the National Health Service in England. It operated in the North West region, which is coterminous with the local government office region.
When created in 2006 it had regional oversight ...
(
North West
The points of the compass are a set of horizontal, radially arrayed compass directions (or azimuths) used in navigation and cartography. A compass rose is primarily composed of four cardinal directions—north, east, south, and west—each sepa ...
region)
#NHS South Central
#
NHS South East Coast
NHS South East Coast was a strategic health authority of the National Health Service in England. It operated in the South East region, along with NHS South Central, providing coterminosity with the local government office region.
History
NHS S ...
#NHS South West (
South West
The points of the compass are a set of horizontal, radially arrayed compass directions (or azimuths) used in navigation and cartography. A compass rose is primarily composed of four cardinal directions—north, east, south, and west—each se ...
region)
#
NHS West Midlands
NHS West Midlands was a strategic health authority (SHA) of the National Health Service in England. It operated in the West Midlands region, which is coterminous with the local government office region. It was abolished in April 2013.
Gener ...
(
West Midlands
West or Occident is one of the four cardinal directions or points of the compass. It is the opposite direction from east and is the direction in which the Sun sets on the Earth.
Etymology
The word "west" is a Germanic word passed into some ...
region)
#NHS Yorkshire and the Humber (
Yorkshire and the Humber
Yorkshire and the Humber is one of nine official regions of England at the first level of ITL for statistical purposes. The population in 2011 was 5,284,000 with its largest settlements being Leeds, Sheffield, Bradford, Hull, and York.
It is ...
region)
These SHAs are coterminous with
government office regions, except that the large
South East England
South East England is one of the nine official regions of England at the first level of ITL for statistical purposes. It consists of the counties of Buckinghamshire, East Sussex, Hampshire, the Isle of Wight, Kent, Oxfordshire, Berkshi ...
region is divided into two: South Central and South East Coast.
Before 2006 reorganisation
#
Avon,
Gloucestershire
Gloucestershire ( abbreviated Glos) is a county in South West England. The county comprises part of the Cotswold Hills, part of the flat fertile valley of the River Severn and the entire Forest of Dean.
The county town is the city of Gl ...
and
Wiltshire
Wiltshire (; abbreviated Wilts) is a historic and ceremonial county in South West England with an area of . It is landlocked and borders the counties of Dorset to the southwest, Somerset to the west, Hampshire to the southeast, Gloucestershire ...
SHA
#
Bedfordshire
Bedfordshire (; abbreviated Beds) is a ceremonial county in the East of England. The county has been administered by three unitary authorities, Borough of Bedford, Central Bedfordshire and Borough of Luton, since Bedfordshire County Council ...
and
Hertfordshire SHA
#
Birmingham
Birmingham ( ) is a City status in the United Kingdom, city and metropolitan borough in the metropolitan county of West Midlands (county), West Midlands in England. It is the second-largest city in the United Kingdom with a population of 1. ...
and The
Black Country SHA (
West Midlands
West or Occident is one of the four cardinal directions or points of the compass. It is the opposite direction from east and is the direction in which the Sun sets on the Earth.
Etymology
The word "west" is a Germanic word passed into some ...
minus
Coventry
Coventry ( or ) is a city in the West Midlands, England. It is on the River Sherbourne. Coventry has been a large settlement for centuries, although it was not founded and given its city status until the Middle Ages. The city is governed b ...
)
#
Cheshire and
Merseyside
Merseyside ( ) is a metropolitan and ceremonial county in North West England, with a population of 1.38 million. It encompasses both banks of the Mersey Estuary and comprises five metropolitan boroughs: Knowsley, St Helens, Sefton, Wi ...
SHA
#
County Durham and
Tees Valley
Tees Valley is a mayoral combined authority and Local enterprise partnership area in northern England, around the River Tees. The area is not a geographical valley.
The LEP was established in 2011 and the combined authority was establish ...
SHA
#
Cumbria
Cumbria ( ) is a ceremonial and non-metropolitan county in North West England, bordering Scotland. The county and Cumbria County Council, its local government, came into existence in 1974 after the passage of the Local Government Act 1972. C ...
and
Lancashire
Lancashire ( , ; abbreviated Lancs) is the name of a historic county, ceremonial county, and non-metropolitan county in North West England. The boundaries of these three areas differ significantly.
The non-metropolitan county of Lancash ...
SHA
#
Dorset
Dorset ( ; archaically: Dorsetshire , ) is a county in South West England on the English Channel coast. The ceremonial county comprises the unitary authority areas of Bournemouth, Christchurch and Poole and Dorset. Covering an area of , ...
and
Somerset
( en, All The People of Somerset)
, locator_map =
, coordinates =
, region = South West England
, established_date = Ancient
, established_by =
, preceded_by =
, origin =
, lord_lieutenant_office =Lord Lieutenant of Somerset
, lord_ ...
SHA
#
Essex
Essex () is a county in the East of England. One of the home counties, it borders Suffolk and Cambridgeshire to the north, the North Sea to the east, Hertfordshire to the west, Kent across the estuary of the River Thames to the south, and Grea ...
SHA
#
Greater Manchester
Greater Manchester is a metropolitan county and combined authority area in North West England, with a population of 2.8 million; comprising ten metropolitan boroughs: Manchester, Salford, Bolton, Bury, Oldham, Rochdale, Stockport, Tam ...
SHA
#
Hampshire
Hampshire (, ; abbreviated to Hants) is a ceremonial and non-metropolitan county in western South East England on the coast of the English Channel. Home to two major English cities on its south coast, Southampton and Portsmouth, Hampshire ...
and
Isle of Wight
The Isle of Wight ( ) is a Counties of England, county in the English Channel, off the coast of Hampshire, from which it is separated by the Solent. It is the List of islands of England#Largest islands, largest and List of islands of England#Mo ...
SHA
#
Kent
Kent is a county in South East England and one of the home counties. It borders Greater London to the north-west, Surrey to the west and East Sussex to the south-west, and Essex to the north across the estuary of the River Thames; it faces ...
and
Medway SHA
#
Leicestershire,
Northamptonshire
Northamptonshire (; abbreviated Northants.) is a county in the East Midlands of England. In 2015, it had a population of 723,000. The county is administered by
two unitary authorities: North Northamptonshire and West Northamptonshire. It is ...
and
Rutland SHA
#
Norfolk
Norfolk () is a ceremonial and non-metropolitan county in East Anglia in England. It borders Lincolnshire to the north-west, Cambridgeshire to the west and south-west, and Suffolk to the south. Its northern and eastern boundaries are the No ...
,
Suffolk and
Cambridgeshire
Cambridgeshire (abbreviated Cambs.) is a county in the East of England, bordering Lincolnshire to the north, Norfolk to the north-east, Suffolk to the east, Essex and Hertfordshire to the south, and Bedfordshire and Northamptonshire to the ...
SHA
#
North
North is one of the four compass points or cardinal directions. It is the opposite of south and is perpendicular to east and west. ''North'' is a noun, adjective, or adverb indicating direction or geography.
Etymology
The word ''north ...
and
East Yorkshire
The East Riding of Yorkshire, or simply East Riding or East Yorkshire, is a ceremonial county and unitary authority area in the Yorkshire and the Humber region of England. It borders North Yorkshire to the north and west, South Yorkshire to th ...
and
Northern Lincolnshire
Northern Lincolnshire describes the northern part of the ceremonial county of Lincolnshire.
For local administration, there are two unitary authorities—North Lincolnshire and North East Lincolnshire—which are separate from Lincolnshire County ...
SHA
#
North Central London SHA
#
North West London SHA
#
North East London SHA
#
Northumberland
Northumberland () is a county in Northern England, one of two counties in England which border with Scotland. Notable landmarks in the county include Alnwick Castle, Bamburgh Castle, Hadrian's Wall and Hexham Abbey.
It is bordered by land ...
,
Tyne and Wear
Tyne and Wear () is a metropolitan county in North East England, situated around the mouths of the rivers Tyne and Wear. It was created in 1974, by the Local Government Act 1972, along with five metropolitan boroughs of Gateshead, Newc ...
SHA
#
Shropshire
Shropshire (; alternatively Salop; abbreviated in print only as Shrops; demonym Salopian ) is a landlocked historic county in the West Midlands region of England. It is bordered by Wales to the west and the English counties of Cheshire to ...
and
Staffordshire SHA
#
South East London SHA
#
South West London SHA
#
South West Peninsula
The South West Peninsula is the area of England between the Bristol Channel to the north and the English Channel to the south. It is part of the South West region of England, and includes the counties of Cornwall, Devon, and (depending on its pre ...
SHA
#
South Yorkshire
South Yorkshire is a ceremonial county, ceremonial and metropolitan county, metropolitan county in the Yorkshire and Humber Region of England. The county has four council areas which are the cities of City of Doncaster, Doncaster and City of Sh ...
SHA
#
Surrey and
Sussex SHA (Surrey,
East Sussex,
West Sussex
West Sussex is a county in South East England on the English Channel coast. The ceremonial county comprises the shire districts of Adur, Arun, Chichester, Horsham, and Mid Sussex, and the boroughs of Crawley and Worthing. Covering an ...
)
#
Thames Valley
The Thames Valley is an informally-defined sub-region of South East England, centred on the River Thames west of London, with Oxford as a major centre. Its boundaries vary with context. The area is a major tourist destination and economic hub, ...
SHA (
Oxfordshire,
Berkshire,
Buckinghamshire)
#
Trent
Trent may refer to:
Places Italy
* Trento in northern Italy, site of the Council of Trent United Kingdom
* Trent, Dorset, England, United Kingdom Germany
* Trent, Germany, a municipality on the island of Rügen United States
* Trent, California, ...
SHA (
Derbyshire
Derbyshire ( ) is a ceremonial county in the East Midlands, England. It includes much of the Peak District National Park, the southern end of the Pennine range of hills and part of the National Forest. It borders Greater Manchester to the nor ...
,
Nottinghamshire
Nottinghamshire (; abbreviated Notts.) is a landlocked county in the East Midlands region of England, bordering South Yorkshire to the north-west, Lincolnshire to the east, Leicestershire to the south, and Derbyshire to the west. The trad ...
,
Lincolnshire
Lincolnshire (abbreviated Lincs.) is a Counties of England, county in the East Midlands of England, with a long coastline on the North Sea to the east. It borders Norfolk to the south-east, Cambridgeshire to the south, Rutland to the south-we ...
)
#
West Midlands
West or Occident is one of the four cardinal directions or points of the compass. It is the opposite direction from east and is the direction in which the Sun sets on the Earth.
Etymology
The word "west" is a Germanic word passed into some ...
South SHA (
Warwickshire
Warwickshire (; abbreviated Warks) is a county in the West Midlands region of England. The county town is Warwick, and the largest town is Nuneaton. The county is famous for being the birthplace of William Shakespeare at Stratford-upon-Av ...
,
Worcestershire
Worcestershire ( , ; written abbreviation: Worcs) is a county in the West Midlands of England. The area that is now Worcestershire was absorbed into the unified Kingdom of England in 927, at which time it was constituted as a county (see H ...
,
Herefordshire
Herefordshire () is a county in the West Midlands of England, governed by Herefordshire Council. It is bordered by Shropshire to the north, Worcestershire to the east, Gloucestershire to the south-east, and the Welsh counties of Monmouthsh ...
,
Coventry
Coventry ( or ) is a city in the West Midlands, England. It is on the River Sherbourne. Coventry has been a large settlement for centuries, although it was not founded and given its city status until the Middle Ages. The city is governed b ...
) †
#
West Yorkshire
West Yorkshire is a metropolitan and ceremonial county in the Yorkshire and Humber Region of England. It is an inland and upland county having eastward-draining valleys while taking in the moors of the Pennines. West Yorkshire came into exi ...
SHA
† known as the 'Coventry, Warwickshire, Herefordshire and Worcestershire SHA until 2004.
The London boundaries were:
* North Central London –
Barnet
Barnet may refer to:
People
*Barnet (surname)
* Barnet (given name)
Places United Kingdom
*Chipping Barnet or High Barnet, commonly known as Barnet, one of three focal towns of the borough below.
*East Barnet, a district of the borough below; an ...
,
Camden,
Enfield
Enfield may refer to:
Places Australia
* Enfield, New South Wales
* Enfield, South Australia
** Electoral district of Enfield, a state electoral district in South Australia, corresponding to the suburb
** Enfield High School (South Australia)
...
,
Haringey
The London Borough of Haringey (pronounced , same as Harringay) is a London borough in North London, classified by some definitions as part of Inner London, and by others as part of Outer London. It was created in 1965 by the amalgamation of ...
,
Islington
* North East London –
Barking and Dagenham
The London Borough of Barking and Dagenham () is a London borough in East London. It lies around 9 miles (14.4 km) east of Central London. It is an Outer London borough and the south is within the London Riverside section of the Thames Ga ...
,
City
A city is a human settlement of notable size.Goodall, B. (1987) ''The Penguin Dictionary of Human Geography''. London: Penguin.Kuper, A. and Kuper, J., eds (1996) ''The Social Science Encyclopedia''. 2nd edition. London: Routledge. It can be def ...
,
Hackney,
Havering
The London Borough of Havering () in East London, England, forms part of Outer London. It has a population of 259,552 inhabitants; the principal town is Romford, while other communities are Hornchurch, Upminster, Collier Row and Rainham. The ...
,
Newham
The London Borough of Newham is a London borough created in 1965 by the London Government Act 1963. It covers an area previously administered by the Essex county boroughs of West Ham and East Ham, authorities that were both abolished by the ...
,
Redbridge,
Tower Hamlets
The London Borough of Tower Hamlets is a London borough covering much of the traditional East End. It was formed in 1965 from the merger of the former metropolitan boroughs of Stepney, Poplar, and Bethnal Green. 'Tower Hamlets' was originally ...
,
Waltham Forest
The London Borough of Waltham Forest () is a London borough in north-east London, England. Its population is estimated to be 276,983 in 2019. It borders five other London boroughs: Enfield to the north-west, Haringey to the west, Hackney to t ...
* North West London –
Brent,
Ealing,
Hammersmith and Fulham
The London Borough of Hammersmith and Fulham () is a London borough in West London and which also forms part of Inner London. The borough was formed in 1965 from the merger of the former Metropolitan Boroughs of Hammersmith and Fulham. The bor ...
,
Kensington and Chelsea,
Harrow,
Hillingdon
Hillingdon is an area of Uxbridge within the London Borough of Hillingdon, centred 14.2 miles (22.8 km) west of Charing Cross. It was an ancient parish in Middlesex that included the market town of Uxbridge. During the 1920s the civ ...
,
Hounslow
Hounslow () is a large suburban district of West London, west-southwest of Charing Cross. It is the administrative centre of the London Borough of Hounslow, and is identified in the London Plan as one of the 12 metropolitan centres in ...
,
Westminster
Westminster is an area of Central London, part of the wider City of Westminster.
The area, which extends from the River Thames to Oxford Street, has many visitor attractions and historic landmarks, including the Palace of Westminster, B ...
* South East London –
Bexley
Bexley is an area of south-eastern Greater London, England and part of the London Borough of Bexley. It is sometimes known as Bexley Village or Old Bexley to differentiate the area from the wider borough. It is located east-southeast of Ch ...
,
Bromley
Bromley is a large town in Greater London, England, within the London Borough of Bromley. It is south-east of Charing Cross, and had an estimated population of 87,889 as of 2011.
Originally part of Kent, Bromley became a market town, c ...
,
Greenwich
Greenwich ( , ,) is a town in south-east London, England, within the ceremonial county of Greater London. It is situated east-southeast of Charing Cross.
Greenwich is notable for its maritime history and for giving its name to the Greenwich ...
,
Lambeth,
Lewisham
Lewisham () is an area of southeast London, England, south of Charing Cross. It is the principal area of the London Borough of Lewisham, and was within the historic county of Kent until 1889. It is identified in the London Plan as one of ...
,
Southwark
* South West London –
Croydon
Croydon is a large town in south London, England, south of Charing Cross. Part of the London Borough of Croydon, a local government district of Greater London. It is one of the largest commercial districts in Greater London, with an extensi ...
,
Kingston,
Merton,
Richmond
Richmond most often refers to:
* Richmond, Virginia, the capital of Virginia, United States
* Richmond, London, a part of London
* Richmond, North Yorkshire, a town in England
* Richmond, British Columbia, a city in Canada
* Richmond, California, ...
,
Wandsworth
Wandsworth Town () is a district of south London, within the London Borough of Wandsworth southwest of Charing Cross. The area is identified in the London Plan as one of 35 major centres in Greater London.
Toponymy
Wandsworth takes its nam ...
,
Sutton
Sutton (''south settlement'' or ''south town'' in Old English) may refer to:
Places
United Kingdom
England
In alphabetical order by county:
* Sutton, Bedfordshire
* Sutton, Berkshire, a location
* Sutton-in-the-Isle, Ely, Cambridgeshire
* ...
These SHAs were replaced by a single London SHA in 2006.
See also
*
Sustainability and transformation plan
In England, a sustainability and transformation plan (STP) is a non-statutory requirement which promotes integrated provision of healthcare, including purchasing and commissioning, within each geographical area of the National Health Service. The ...
– a 2016 reorganisation of NHS England
References
Further reading
*
{{DEFAULTSORT:Nhs Strategic Health Authority
National Health Service (England)
2002 establishments in England
Government agencies established in 2002
2013 disestablishments in England
Defunct National Health Service organisations
Former subdivisions of England