At a time of acute financial and service challenges, this report asks where responsibility for leading improvements will rest in future. The report outlines the changes accomplished in the past 18 months, building on a 2011 analysis by The King's Fund and recent interviews with NHS leaders. The report's authors argue that the new NHS structures are unlikely to provide the leadership needed to meet the challenges ahead – and they are by no means a permanent solution. The complexity and urgency of the challenges facing health care in London require a radically different approach to the rest of England.
- Although there has been some progress in implementing service change since the Fund's last review in 2011, much remains to be done in London and this is becoming a matter of urgency.
- Reorganising the NHS in London so fundamentally has made a challenging situation much more difficult, as did the Health Secretary's decision in 2010 to halt the work already initiated on service change.
- The implementation of further service changes in London will depend on the establishment of 'constellations of leadership' among the various stakeholders around different issues.
- The complexity and urgency of the challenges facing health care in London may require a radically different approach to the rest of England and consideration should be given to commissioning and providing services differently in the capital.
- One option would be to concentrate responsibility for commissioning in a London-wide strategic body and to establish three provider networks, based on the proposed academic health sciences networks.
- Under this option, experienced clinical and managerial leaders would lead implementation of overdue service changes at scale and pace.
- Failure to address the need for system leadership and to drive forward change could result in a health care system for London that is financially unsustainable and unable to deliver consistently high standards of care.
- Chris Ham's blog post on the need to improve London's NHS
- Details on London's acute hospitals and their configuration
- Our infographic showing the relationships between health bodies in London
- Highlights from the report launch: What are the prospects for service change?
- Our press release on this report
- More of our work on health and heath care in London