Shifting the balance of power within the NHS (2001)

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). In future:

  • the executive regional offices of the NHS would be abolished
  • 30 SHAs would replace 95 health authorities (whose role had diminished) and take the lead in strategic development of local health services (taking over some functions from the regional offices) and management of PCTs and NHS trusts. However, they would no longer be involved in planning and commissioning services
  • 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 paper brought forward the date of establishing PCTs from April 2004 (as mentioned in the NHS Plan) to April 2002, when ‘devolution day’ saw massive changes throughout the system. It was also intended that PCTs would receive and manage 75% of total NHS expenditure, with resources allocated directly to PCTs rather than to SHAs.