of providers were achieving foundation trust 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. Facilities owned by SHAs were transferred to NHS Property Services, and their public health functions to Public Health England. Role Each SHA area contained various NHS trusts which took responsibility for running or commissioning