“Strategic vacuum” after end of NHS London threatens patient care in the capital

BMJ 2011; 343 doi: (Published 13 December 2011) Cite this as: BMJ 2011;343:d8130
  1. Zosia Kmietowicz
  1. 1London

The government needs to spell out who will be responsible for coordinating health services across London when the capital’s strategic health authority is abolished in April 2012, says the healthcare think tank the King’s Fund.

A report from the fund warns that the situation raises “a real risk of declining financial performance and a failure to tackle unacceptable variations in the quality of care in the reformed NHS.”

The Health and Social Care Bill, which is currently before parliament, does not deal with what the fund refers to as “a strategic vacuum” in the coordination of London’s health services.

Clinical commissioning groups, which will take on responsibility for commissioning most NHS services under the bill, are unlikely to be able to provide the leadership needed. Instead they “will need to work with the NHS Commissioning Board, local authorities and providers to bring about further improvements in care,” says the report.

It adds, “The time it takes to bring about complex service changes adds urgency to the work that needs to be done. The government must explain who will take the lead in improving health and health care in London and how the many different organisations that have an interest in doing so will work together to ensure that Londoners have access to health care of the highest possible standard within the resources available.”

Chris Ham, chief executive of the King’s Fund, said, “London’s NHS is in urgent need of change, but the risk is that no one will be in the driving seat to push through the changes needed to improve patient care. New pan-London health organisations are emerging, but none has a clear mandate to take the lead. Strategic leadership is important across the NHS, but in London it is particularly important as the challenges are more acute and urgent.”

These challenges include concentrating emergency care in fewer hospitals, which an analysis by NHS London has shown could save up to 500 lives a year. In addition, high rates of dissatisfaction with GP services and large health inequalities need to be tackled.

Although services in the capital have seen some improvement under the healthcare for London programme recommended by the former health minister Ara Darzi in December 2006—notably in the reorganisation of stroke and trauma care—the programme was abandoned when the coalition government took office in May 2010.

The report also warns that the NHS in the capital could face severe financial difficulties as budgets tighten over the next few years: 18 of London’s 31 acute care trusts are forecast to have a net deficit totalling around £170m (€200m; $265m) by 2014; about 13 trusts are unlikely to be financially viable by 2014, the deadline for all trusts to gain foundation status; and London’s NHS faces costs from private finance initiatives of £19bn to be paid by 2048, much higher than elsewhere in the country.


Cite this as: BMJ 2011;343:d8130


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