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Editor's blog Thursday 16 June 2011 EXCLUSIVE: 10 SHAs clustering to 4 by October. And 8 commissioning support units?

- Current 10 SHAs will cluster to four 'super'-SHAs by October 2011
- These four bodies set to form regional 'arms' of the NHS Commissioning Board


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Health Policy Insight has learned that the clustering of strategic health authorities is to result in four bodies by this October.

These four 'merged' SHAs are set to form the basis of the future NHS Commissioning Board's regional branches, which have referred to in some draft documentation as the "field force".

The SHA clustering process will take place by October 2011.

NHS London SHA is being preserved in its current form.

NHS North East and NHS North West SHAs are joining up to become NHS North.

The composition of the remaining two remains under negotiation, but it is thought likely that the other seven current SHAs will cluster along the lines of NHS South (probably a grouping of NHS South West, NHS South Central and NHS South East Coast) and NHS Midlands (likely to include NHS East Midlands, NHS West Midlands, NHS East Of England and NHS Yorkshire and Humber).

Details of who will be appointed to the chief executive roles of the merged SHAs are not yet known, although it is suggested that the current group of SHA CEs will provide the 'talent pool'.

Strategic health authorities are statutory organisations, and therefore they will continue to exist nominally, as PCTs have done.

The implications for workforce are currently unclear, but management and staff cost savings will certainly be a target.

Clarity is also lacking about the proposed relationship between the four branches of the future NHS Commissioning Board and the 'clinical senates' proposed by the NHS Future Forum and accepted by the Government.

UPDATE: With thanks to correspondents for corroboration of the above and for fresh information, the DH is considering plans for clustered PCTs to further cluster up from the current 50 and form a basis for eight commissioning support units, with average populations of 5 million each.

This follows the DH's just-finished internal capability review, assessing the strengths and gaps in current NHS commissioning ability in PCT clusters.

The DH's recent regional Accelerated Learning Events have featured the commercial presences of BMJ Group, Capita, KPMG, PA Consulting and UnitedHealth.

There is debate about what is the appropriate scale and degree of localism versus what is economically and logistically better provided on a more centralised basis. We will return to discussion of this issue.

The debate about scale is not yet concluded in the DH, but NHS Commissioning Board CE-designate Sir David Nicholson is known to favour the eight support units covering larger populations: an option also likely to appeal to the Treasury.

Readers with any further information can email editorial AT healthpolicyinsight.com