Leading health care in London: Time for a radical response

Posted:26 June 2013
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Publication details

ISBN: 978 1 909029 11 8
Pages: 40

The recent NHS re-organisation and the abolition of strategic health authorities and primary care trusts have resulted in an absence of health system leadership in London.

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.

Key findings

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.

Policy implications

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.

Comments

The Central London Clinical Commissioning group, which took over in part from the Westminster Primary Care Trust, with a yearly budget of £250 million, does not seem to have a proper office dealing with phone calls and emails. I twice emailed them a question on care for the elderly in Westminster to be discussed at their March board meeting. I had no acknowledgement of said emails, their phone does not answer and their board meeting was moved up a week without mentioning this on their website.

Sica in Collaboration with the African Women's Forum Org, are seeking to fund some project and would know how you can support and the protocols to engage with this organization.

The evidence for change and for specialist units does not negate the need for local DGHs. It is just that their role will change into assessment, transfer and sorting stage posts on the input side, and rehabilitation and distribution on return from specialist centres (output side) or after acute illness.
It is the selling of specialisation, particularly to rural communities that has been deficient. In West Wales European money has not been used to improve comunication links - which would have allowed for the sensible option of a specialist centre in the middle of the area.. In Norfolk the potential is restricted by PFI - and the demographics combined with the financial pressures mean rationing is increasing and inevitable.
The case for overt as opposed to covert rationing is building up and the evidence of the last 4 months is on www.NHSreality.wordpress.com ....
It will increase and I will try to encorage colleagues in the Regional Health Services to testify on retirement or exit from a post..
It is the politicians who are in denial. All of us know the truth but it remains unspoken..

A packed auditorium this morning had a preview of this report. Especially helpful I thought was the distinction between reorganisation (structures) and reconfiguration (services) - the former, not fit for purpose, the latter, vitally important in the context of the complex new structures we in England now have to use. So what is the political space (big p and little p) available for reconfiguring leaders? And who are the leaders anyway? The KF wants the regulators to back off from competition demands to allow reconfiguration to happen. And speakers demonstrated the importance of and some of the routes to real clinical engagement - whole system reconfiguration for demonstrable patient benefit.
The doctors are key to this, but so too, came, the message from the floor, are other clinicians. Yet something more is needed I would argue, for a truly compelling narrative capable of service improvement through redesign - the support of local citizens and service users. No-one picked up Anne Rainsberry's point that late stage consultation has not worked and that something more active is needed.
This is the KF arguably at its most radical yet, but still one might say too health care centred, NHS focussed doctor driven. Moreover, are AHSNs best constituted for leading on this? And is London really the special case for that notion of regulatory relaxation? I am looking forward to a close read of this report. I have a feeling it might be the start of a much needed new phase of thinking and action for our health service.