London calling: health and inequalities in the capital

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Part of 120 years of The King's Fund

The latest in our series of blogs celebrating the Fund’s 120th anniversary looks at the London Programme: a co-ordinated programme of development work and grant giving set up by the Fund in 1979 with the aim of improving health care in the capital.

Throughout the 1970s the UK’s struggling economy had an impact on all public services, including health care. Health services in London were further affected by a national restructuring of government health funding that reduced the capital’s budget (p 6). In response to this, The King’s Fund set up the London Project Executive Committee in 1979 to ‘consider how the Fund could help tackle the special problems of health care in the inner-city areas’ (p 8). The London Programme was the result.

The early work of the London Programme included a series of conferences, direct grants to innovative projects, and publications. During this time, the Programme worked closely with the London Health Planning Consortium chaired by Donald Acheson, who would later become the UK's Chief Medical Officer. The Consortium’s 1981 report, Primary care in inner London, influenced the direction of the Programme with its emphasis on the relationship between primary care and hospital services and a priority on disadvantaged groups in the city’s population.

One of the Programme’s areas of work during this decade was focused on encouraging primary care services to be more responsive to the needs of local communities. The Programme gave a grant to the Identification of underprivileged areas study, led by Brian Jarman, which analysed 1981 census data to identify areas of health inequality (p 48). In 1984 the Programme published Information for health services planning from the 1981 census and Information about district health authorities in England from the 1981 census explaining how small area statistics from the 1981 census could be used as indicators in health services planning.

Another area of concern at this time was how services could better meet the health needs of London’s black and minority ethnic communities. The Programme took a number of approaches to addressing this, from documenting what was already happening in the London area to bringing together those with specialist knowledge (p 46) to inform the direction of the Fund’s work. Conferences, such as An experiment in advocacy: the Hackney multi-ethnic women’s health project, promoted good practice and stimulated debate on issues such as racism.

In 1985 the Programme expanded its remit beyond London when the Department of Health and Social Security provided £500,000 funding for a number of projects looking at inner city primary health care more generally (p 36–7). The following year the government published its Green Paper, Primary health care: an agenda for discussion, and the Programme responded with a series of workshops to discuss some of the proposals.

The London Programme became known as the Primary Health Care Group in 1987, with the London Project Executive Committee continuing to advise and steer the Fund’s work on primary care and allocate grants to inner city primary care projects. Since the 1980s, the Fund has continued to build on this work to understand the specific health needs of large cities, and it remains an area of the Fund’s focus to this day.

Our next 120th anniversary blog will look at the changing focus of The King’s Fund’s work during the 1980s and 1990s.

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