'Shifting the balance of power within the NHS' white paper

The government published Shifting the balance of power within the NHS in July 2001, the pervading theme of which was the devolution of responsibilities to frontline staff and communities. The Department of Health outlined further details of the development of primary care trusts (PCTs) and proposed the establishment of strategic health authorities (SHAs).

The government planned to:

• abolish the executive regional offices of the NHS
• replace the 95 health authorities (whose role had diminished) with 30 SHAs. These would take the lead in strategic development of local health services (taking over some functions from the regional offices) and the management of primary care trusts (PCTs) and NHS trusts. However, they would no longer be involved in planning and commissioning services.

'Devolution day' on 1 April 2002 saw massive changes throughout the system. The paper brought forward the date of establishing PCTs from April 2004 (as mentioned in the NHS Plan) to April 2002. It also intended that PCTs would receive and manage 75% of total NHS expenditure.

Resources would be allocated directly to PCTs rather than to SHAs. PCTs would lead NHS organisations in assessing need, planning and securing services and would be expected to work in partnership with local bodies, such as local authorities. The white paper advocated a new public health system that would consist of:

• a public health team in every primary care trust (PCT), leading on health improvement and reducing health inequalities
• strong regional public health groups co-located in the nine regional offices of government, and led by a regional director of public health focusing on the development of a multi-sectoral approach to tackling the wider determinants of health
• a director of public health in each strategic health authority (SHA), taking responsibility for the performance management of the local public health function, the development of clinical networks and the creation and the development of a public health network
• a health protection function to reduce risk and manage problems arising from communicable diseases and environmental hazards.