Strategic Health Authority visions

What are the Strategic Health Authority (SHA) visions and why are they important?

The visions are the strategic frameworks produced by each SHA (except London, which is one year in advance) to both inform the Next Stage Review (NSR) by Lord Darzi, Parliamentary Under-Secretary of State for Health and to identify:
  • The current health and well-being problems of their population
  • Aspirations for the population and the health service over the next 10 or so years (South West SHA sets out the ambitions and actions for 2008 - 2011 in the context of the vision for the next ten years)
  • Inadequacies of existing services
  • The barriers/enablers to change
Some of the visions also identify some potential 'quick wins', short-term plans (to 2011) others also take a view as to potential needs in 20 years.

These SHA strategic frameworks, alongside the national NSR reports (see main page in this section for more details) set the parameters, which will determine the priorities for improving the health of the population within the region over the next 10 years. They will shape the commissioning strategies of the Primary Care Trusts (PCTs) and the operating and business plans of providers (both NHS and others), for example, the size and nature of the workforce and the buildings and equipment. The visions also set out aspirations for behaviour change by the public supported by the health service and how users access those services.

Your local SHA vision document is essential reading for all members. Links to the documents for each SHA (except London) are below with additional notes to provide a 'flavour' of the content of each. Members should also scan the notes for the other SHA documents, as this will give some indication of the extent of change of organisational culture that is underway in the NHS and the new mindset required by all health and well-being professionals to take advantage the proposals, or at the very least to remain relevant.

To find out which SHA covers your region visit the Office of the Strategic Health Authorities website: www.osha.nhs.uk This website will also direct you to each SHA website.

Timetable/process

In each SHA area, the following process will be followed; members should refer to their local SHA vision for exact details:
  • May/June - publication of 'vision' - many SHAs are consulting on the vision
  • July/August - PCT engagement events with a view to informing the drafting of the PCT strategic frameworks (the commissioning strategies) for 2008/9 - 2010/11
  • during August – consultation’s on vision documents end
  • October - publication of PCT strategic framework
  • October/November - publication of final SHA vision
  • January 2009 - publication of PCT strategic frameworks and NHS Trust Operational Plans. NHS Foundation Trusts and the independent sector will have taken account of the SHA vision in producing their business plans

Common elements

Each document sets out the case for change:
  • Changing population demographics, such as growing older population (all areas), a decline in population numbers overall (North East), or pockets of particular health needs associated with specific ethnic minority populations (North West)
  • Population behaviours resulting in differing needs according to whether the population is less healthy than the national average (North East) or more healthy (East of England)
  • Environmental factors, such as major growth areas along the M11 corridor and the Thames Gateway (East of England)
  • The operation of the health service and how the population accesses services with an over reliance on hospital based care (North East) or an absence of some services completely, such as specialist stroke treatment 24/7 (East Midlands).
All the SHA's followed the 4 broad themes identified in Lord Darzi’s Interim Report published in October 2007:
  • Access
  • Dignity and the patient as a person
  • Integrating care and partnership
  • Choice and personal control
These underpin the aspirations set out in each vision.

Most of the SHAs followed the national NSR approach and divided services into the 8 clinical pathways:
  • Staying healthy
  • Long-term conditions (LTCs)
  • Mental health
  • Acute care
  • Planned care
  • Maternity and newborn care
  • Children’s services
  • End of life care (EoL)


The South West vision and East Midland vision have varied this list by adding learning disabilities. All SHAs established regional clinical groups for each pathway area to assess the status quo and identify what might be achieved in the future and what would be required to do so. Some SHAs (East Midlands) established county clinical groups to support the regional work. The work of these regional groups, coupled with the initial feedback from the user and public engagement events formed the basis of the visions. In many SHAs the reports of each clinical pathway group are also available. It is envisaged that in many SHAs these regional clinical groups will continue to exist in some form to assist with monitoring and implementation of the visions.

Further information

For more information, please see the CSP policy briefing SHA Vision Synopsis.

This text on this page was last updated on 6 Aug 2008.