Editor’s blog Thursday 4 March 2010: SHAs - ten to four, and some thoughts about the NHS untermarket

Ten to four SHAs is the latest rumour, chaps. North, Midlands, South-West and South-East, is what they are apparently discussing.

What is the point here? Strategic health authorities have always been mis-named: they are not strategic. They have a degree of authority, vired from The Richmond House, 79 Whitehall (proprietors: Centralising Caped Crusader Sir David Nicholson and Boy Wonder Andy Burnhoid; licensed vendors of visions to gentlemen and their sons), but they are effectively the intermediate arm of the centre.

Why do we have an intermediate tier? Because we always have had one, is the first thing to say.

Is this a meaningful curbing of management costs? That depends on your view of the role of the intermediate tier. Some people don't think they have one. Others grudgingly accept that as well as the role in workforce training, there is a role to 'hold the ring' on a region-wide basis in financial management (somebody's got to hold all those PCT top-slices), and as a semi-official arbiter of disputes - as well as their role in the world-class commissioning assurance process.

Aggregating the functions upwards, into four huge bodies, will make them less 'local' - as happened with the last big structural reform when 300 PCTs became 152 and 30 SHAs became 10. It is a fascinating irony that the policy vogue is moving back towards clinical collectives, which sound rather like the 300-odd primary care groups (PCGs), that became (too soon) PCTs.

Alchemy: base metal, fool's gold
This would be a move from SHA to ORE - Office of the Regional Executive. Off, SHA: ORE.

Or OFFSHORE?

A thought on the NHS untermarket
Reflecting back on my earlier post today, here is a quick thought.

How do you stimulate the market - a world-class commissioning core competency - when the NHS is the "preferred provider"?