Strategic health authorities (SHA) were part of the structure of the National Health Service in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementing health policy as required by the Department of Health at a regional level. History In 2002, the existing regional health authorities were renamed and merged to form 28 new strategic health authorities, under the National Health Service Reform and Health Care Professions Act 2002. This was the first time that the regional tier in the NHS reported directly to the centre rather than having a board and non-executive members. The SHA chief executives were appointed after a wide-ranging search and selection process and did not represent continuity with the previous regions, not least because CEOs were allocated to areas they were not generally familiar with. A number of the new CEOs had previously been health authority CEOs or CEOs of large trusts, rather than being on the traditional path. The role of the SHAs was set out in Shifting the Balance of Power within the NHS – Securing Delivery and included the following: The goal was to create a coherent strategic framework for the development of services across the full range of local NHS organisations, including: Performance management Brokering solutions where there were disputes Building capacity and supporting performance improvement Preparing and delivering cohesive strategies for capital investment Working with workforce confederations (in some unspecified way) Ensuring effective professional leadership across their area. Evolution A pivotal event seems to have been a loss of financial control in 2005/6 and a failure of the management system to respond quickly or firmly enough. This, combined with some ministerial ambivalence about the effectiveness of SHAs and a promise in the 2005 election to reduce NHS management spending, led to Patricia Hewitt, Secretary of State for Health to announce that, following an NHS consultation which ended in March 2006, the SHAs were to be reorganized. They were reduced to ten in number by the Strategic Health Authorities (Establishment and Abolition) (England) Order 2006, as amended, and this was expected to produce substantial financial savings. At the same time there were other important changes that had implications for the functioning of SHAs: Span of control – the number of PCTs was reduced to 152 from 302 in 2002 (although there had been a continuous process of mergers). At the same time, an increasing number