London must grasp opportunity to improve health and care services, says new report

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The capital’s complex and cluttered health and care system is hampering plans to improve Londoners’ health, according to a new independent report from The King’s Fund.

The report, Sustainability and transformation partnerships in London, commissioned by the Mayor of London, reviews the progress made over the past year by the capital’s five sustainability and transformation partnerships (STPs), new bodies established to implement local plans for the future of health and care services. It finds evidence of improvements in services for patients in boroughs and neighbourhoods across London which are often supported by the partnerships, but that London’s STPs are less advanced than those in many other parts of England.

The analysis found that the partnerships have spent much of the past year trying to overcome the problems associated with the nationwide introduction of STPs, which was undermined by a lack of engagement with the public and saw them unfairly labelled as vehicles for cuts and privatisation. As a result, London’s STP leaders have spent much of their time over the past 12 months focusing on the internal workings of the partnerships, building relationships with their partners and addressing gaps in staff and public engagement.

Leaders interviewed for the research reported that proposed cuts to hospital beds and challenging financial assumptions outlined by some of the STPs have been dropped in recognition that they were not realistic in the face of population growth and increasing pressures on services.

The report highlights London’s complex health and care system which, in addition to the five STPs, includes 36 trusts and foundation trusts, 32 clinical commissioning groups, 33 borough councils, the Mayor and Greater London Authority, 33 health and wellbeing boards, three academic health science networks, the London Health Board, London Strategic Partnership Board and Healthy London Partnership, and the regional outposts of several national bodies.

The report argues that this complexity has created challenges for the five STPs and suggests that the forthcoming appointment of a London regional director working across NHS England and NHS Improvement provides an opportunity to address this. It also argues that the Mayor has a key role to play in providing pan-London leadership and calls for an urgent review to clarify the capital’s cluttered organisational landscape and develop a clear and compelling vision for the future of health and care in London.

Helen McKenna, one of the report’s authors and Senior Fellow at The King’s Fund, said: ‘London is home to world-class health and care services but also faces significant demographic, operational and workforce pressures. Its five STPs have a crucial role to play in working alongside NHS bodies, the Mayor and the boroughs to improve services for patients but are currently trailing behind STPs in other parts of the country.

‘While progress is being made in improving services at a borough and neighbourhood level, the STPs need to do more to demonstrate their impact. Now is the time to review London’s complex and cluttered organisational landscape and develop a clear and compelling vision for the future of health and care for Londoners.’

Notes to editors

This press release and the full report, Sustainability and transformation partnerships in London: An independent review are embargoed until 6.00 on Tuesday 16 October. After this time, the full report will be available here: https://www.kingsfund.org.uk/publications/sustainability-transformation-partnerships-london

The five London STPs are North London Partners in Health and Care (North Central London), East London Health and Care Partnership (North East London), North West London Health and Care Partnership, Our Healthier South East London and South West London Health and Care Partnership.  

Research for this report was carried out in two phases between February and August 2018. Phase one involved a small number of interviews with leaders of the five STPs and from NHS England’s and NHS Improvement’s London regional teams, and phase two involved a series of 26 interviews with senior NHS and local government leaders in each STP and with stakeholders working across the wider London system. We also held a roundtable discussion attended by 19 senior leaders from across the London health and care system and a group discussion with 17 representatives from London Healthwatch organisations. This report is based on the interviews undertaken, previous work by The King’s Fund, and our wider understanding of the issues across health and care and the London context.  

For more information or to request an interview with one of the authors please contact:

Gemma Umali, Press and Public Affairs Manager, The King’s Fund
g.umali@kingsfund.org.uk, 020 7307 2583 (07584 146 035 if calling out of hours)

The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.