Final Report > Chapter 24: A Health Service which is Well Led > The leadership and management of the NHS > Leadership at the level of the health authority

Leadership at the level of the health authority

18 As we have indicated, there needs to be leadership at a level between the national and the local. The DoH cannot descend to the detailed needs of individual trusts and trusts need more guidance and, on occasions, control than can be exercised through general strategic direction. The history of the NHS over the past decades is one of wrestling with this problem without ever entirely resolving it. The recent decision to rationalise the intermediate tier and to have only 30 health authorities between the trusts and the DoH is, in our view, the right way forward. It allows the concerns and needs of a wider population than that served by any trust to be taken account of. It also allows national strategic goals to be translated into, and adapted to, the circumstances of a particular area and then passed down to the individual trust. Perhaps most importantly, in terms of the lessons of Bristol, it means that the actions and ambitions of trusts (including primary care trusts) can be co-ordinated according to some rational and cost-effective plan which serves the interests of all within the health authority. For example, a proposal by a trust to embark on a new area of healthcare service will have to be agreed by the health authority. If it is judged inappropriate, as not meeting or responding to the needs of the local population, funding would be denied. This is a powerful tool in the development of a better planned and more coherent NHS.