Leading health care in London: how will the new NHS and public health system work?

The absence of a designated system leader in London means that there will need to be a process of mutual adjustment when aligning a large number of participants, networks of both individuals and organisations, and stakeholders from different sectors in the new system, sometimes with quite different objectives.

The NHS lacks experience in implementing improvements in an eco-system because change has more typically occurred through concentrated leadership. In rising to the challenge of managing change in the new environment, everyone involved will have to learn how to handle the new arrangements and many will have to adjust to different roles, relationships and ways of working – while also dealing with growing and unprecedented financial and service pressures.

This figure first appeared in our report: Leading health care in London: Time for a radical response