For more than 100 years, reviews of health care in London have highlighted the poor health of the population in some areas, variations in the quality of primary care, and inappropriate configuration of hospital services.
The most recent review, led by Ara Darzi, set out some proposals for change, many of which were implemented by NHS London. However, the coalition government has halted these reforms and offered different criteria for change.
Many of the historical problems remain and the crucial question, highlighted by The King's Fund's latest report is: who will take the lead in improving health and health care in London? London is at risk of operating within a strategic vacuum following the abolition of London's strategic health authorities by April 2013.
Improving health and health care in London suggests there needs to be much greater clarity of roles and responsibilities within the reformed structure to avoid ambiguity and confusion.
The particular challenges for London are:
- The financial situation in London is more difficult than predicted at the time of the Darzi review; both providers and commissioners are forecasting deficits greater than those in other parts of the country. Furthermore, very few of the trusts that should be aiming to achieve foundation status by 2014 are likely to be financially viable by that date.
- Variations in the quality of both primary and secondary care persist: patients report poor quality care in general practice; health inequalities need to be addressed; reconfiguration of hospital services is needed to save lives.
- In the absence of a strategic health authority, there is considerable uncertainty about who will make the difficult decisions about issues that affect the whole of London.
Improving health and health care in London presents an overview of the current financial position and the distribution of activity and resources around the various sectors of London. It assesses the likely impact of the new government's NHS reforms and concludes with some suggestions of ways to facilitate appropriate service change, improve the quality of care, and improve the health and health outcomes of Londoners.