No one should mourn the demise of Strategic Health Authorities. The main 'strategic' thing they did was move money around the NHS to hide failing organisations
In the last few weeks I have been fortunate enough to have been involved in a simulation exercise about how the new NHS architecture will work. I don’t know if you have ever been a part of a simulation, but they gained traction in the early 1990s.
Since then the method has been used many times to understand how a policy works its way through, giving real clinicians and managers the opportunity to work and behave within the new NHS architecture.
What is interesting about such simulations is how both the small and the big changes work. If we role play from the year 2013 to 2014 we quickly see the big decisions looming for the local NHS.
Inevitably, given the coming demise of Strategic Health Authorities, some people feel that the tier of management that developed strategy is going and that the capacity to make strategy will go with it.
But that is to confuse titles with reality. Just because an organisation is called a Strategic Health Authority does not mean that it created strategy. What SHAs mainly did was to pass down actions that were expected by the centre.
So given the stock management culture of the NHS this meant that the NHS Management Board raised its voice a little on a Tuesday, the SHAs shouted at the PCTs on a Wednesday - and at the NHS providers left (who did not have Foundation Trust status) on the Thursday.
Whatever this was we should not mistake it for strategy.
And it is at this time of year – towards the end of year closing of accounts – when what passed for strategy took place at highest volume in the NHS. For this is the time when the Department of Health expects the SHAs to ensure that as few NHS organisations as possible end up in deficit.
It was therefore at this time of year that PCTs and their local NHS providers were summoned by the SHA to gather in darkened rooms where the PCTs would be leant on to cough up a few million pounds to providers to make sure that they weren’t in deficit. Never mind the fact that they were in deficit and had economically failed that year. The role of the SHA was to lean on the PCT to cough up a bit more money to make the books balance.
The role of the Strategic Health Authority is effectively to make the PCT take money from organisations that are succeeding, to pay for organisations that are failing.
Again, you can call this process whatever you like – ‘bungs’ is quite a good name – but it is definitely not a strategic approach to developing the NHS.
And as I have travelled the country over the last few weeks I have heard this traditional bullying of PCTs going on as normal. With only 6 weeks to go, learnt SHA behaviours are still being carried out to the end.
So who will do this next year? Certainly there are elements in the National Commissioning Board who think it is still their job. (This is hardly surprising since so many NCB staff have a track record both of running NHS providers and holding senior management positions in the NHS).
But the big difference next year will be that the organisation that needs to organise the payments – the NHS Trust Development Agency – will be separate from the organisation that can lean on the Clinical Commissioning Groups – the National Commissioning Board. I am sure there will be elements of the NCB who will see this as their job, but the transfers won’t be able to flow from one part of a single organisation to another.
I am sure the NCB will, over the year, build what they will see as a failed NHS hospital emergency fund. But their crisis, the one that matters to their organisation, will be the problems within CCGs.
The NCB will be judged over 2013/4 on the success of CCGs and not by the size of the deficits in the remaining non-FT NHS trusts. That will be a separate problem for a completely different organisation.
So the passing of the SHAs will not mean the passing of strategy, but it will mean the passing of a single organisation that could, in the last 6 weeks of every year, move money around to hide those NHS organisations that are failing.
Not sure if that is worth a tear or a cheer?
Paul Corrigan was formerly senior health policy adviser to Tony Blair when he was prime minister. The original version of this post first appeared on Health Matters
