Leadership vacuum threatens patient care in London

The King's Fund today calls on the government to spell out who will be responsible for improving Londoners' health and health care following the abolition of the strategic health authority. 

Our new report, Improving Health and Health Care in London: Who will take the lead? shows that London's NHS is facing significant financial problems and an urgent need to improve the quality of care. The report says:

  • Hospital services need to be reorganised to save lives and improve care. For example, analysis has shown that concentrating emergency care in fewer hospitals could save up to 500 lives a year in London.
  • GP performance in the capital is often poor. Londoners report greater dissatisfaction with GP services than patients elsewhere in the country– London ranked the worst of all regions on 26 of 31 questions in the 2010/11 GP patient survey.
  • Large health inequalities persist. For example, death rates in Tower Hamlets are nearly 90 per cent higher than in Kensington and Chelsea because of the poor health of the population.

These problems remain despite some significant improvements under the Healthcare for London programme– which was scrapped in 2010 – such as the reorganisation of stroke and trauma services.

The report also warns that the NHS in the capital could face severe financial difficulties as budgets tighten over the next few years:

  • Some trusts face significant and growing deficits – 18 hospitals are forecast to have a net deficit of around £170 million by 2014.
  • Many London trusts will struggle to meet the government's deadline to become foundation trusts by 2014 – only 16 of 42 London trusts are currently foundation trusts, with around half of the remainder unlikely to be financially viable in time to meet the deadline.
  • London's NHS also faces much larger private finance initiative (PFI) commitments than elsewhere in the country, with an estimated £19 billion in PFI costs due to be paid by 2048.

Chris Ham, Chief Executive of The King's Fund, said:

'London's NHS is in urgent need of change, but the risk is no-one will be in the driving seat to push through the changes needed to improve patient care. New pan-London health organisations are emerging, but none has a clear mandate to take the lead. Strategic leadership is important across the NHS, but in London it is particularly important as the challenges are more acute and urgent.'

The report says that the abolition of the SHA from April 2013 leaves a strategic vacuum and lack of clarity about responsibility for co-ordinating health services across London – a problem not addressed by the Health and Social Care Bill which is currently before parliament.

It says that a combination of perspectives is needed to drive forward the required changes, which brings together the NHS Commissioning Board, clinical commissioning groups, health and wellbeing boards and health care providers. But it warns that this will fail unless it is clear who is responsible for overall pan-London leadership and co-ordination.

Notes to editors: 

  • For more information or to request an interview with Chris Ham, please contact the Press and Public Affairs office at The King's Fund on 020 7307 2585 (if you are calling out of hours, please ring 07584 146035). 
  • Improving Health and Health Care in London: Who will take the lead? is published by The King's Fund on Tuesday, 13 December 2011.  
  • In December 2006, NHS London (London’s strategic health authority) asked Lord Darzi to develop a five to ten year strategy for London's NHS. The result was Healthcare for London: A Framework for Action. The Healthcare for London programme was discontinued in May 2010. However, a number of pan-London NHS programmes remain under the leadership of NHS London. 
  • NHS London published Adult Emergency Services: Acute medicine and emergency general surgery, case for change summary in September 2011. The report states that at least 500 lives could be saved in London if the weekend mortality rate for emergency care was as low as the weekday mortality rate. 
  • An analysis conducted by NHS London this year (the 'Sustainable and Financially Effective' analysis, covering non-specialist acute hospitals only) suggests that at least eight trusts will not be in a position to attain foundation trust status by 2014. The analysis suggests 18 hospital trusts will have a combined net deficit of £170 million by 2014. 
  • The £19 billion in PFI costs due to be paid by 2048 was calculated through analysis of HM Treasury data.