The general role of Regional Health Authorities
The National Health Service in England has 14 Regional Health Authorities (RHAs) and around 190 District Health Authorities (DHAs). Each RHA covers several million people, the average DHA has a population of around a quarter of a million people, though there is considerable variation in the size of each type of authority.
Managerial accountability
DHAs are accountable for their performance to their RHA, which are, in turn, accountable to the Department of Health (DoH). The RHAs have a number of roles, predominantly related to strategic planning and the monitoring of districts' performance. They have a general leadership role, and have traditionally managed specific services that are too small or specialised to be run cost effectively by districts. Thus, RHAs set the broad context for services and their development, leaving detailed plans to be developed by districts. Regions then assess the achievements of DHAs in achieving both broad and detailed plans.
The new role of health authorities
In the past, DHAs have been responsible for the provision of the health services situated within their boundaries. With the changes outlined in the NHS White Paper, Working for Patients, now enacted as law in the National Health Service and Community Care Act, 1990, they have become responsible for the health and health care of their resident populations.