ADD2763 Mayor’s tests for major NHS service changes – assessment 2025

1.1.    The Mayor has committed to championing and challenging the NHS on behalf of all Londoners, as part of his ambition for London to be the healthiest global city and to tackle health inequalities. 
1.2.    In 2017, in response to a report commissioned by the Mayor into London’s five Sustainability and Transformation Plans (approved under ADD2067), he announced a framework of ‘tests’ he expected to be met before he gave his support to any major health and care transformation, or hospital reconfiguration proposals in London. The current framework of tests covers:
•    health and healthcare inequalities 
•    hospital-bed capacity 
•    impact on social care 
•    patient and public engagement. 
1.3.    This Assistant Director Decision (ADD) form is seeking approval to procure expert external consultancy services, up to £25,000, to prepare an assessment against the Mayor’s tests of an upcoming NHS proposal to reconfigure healthcare services. The proposal relates to adult cancer services in north west London, and is expected to go to public consultation in summer 2025.   
1.4.    The following decisions have previously been agreed for expenditure to assess major health service reconfigurations against the Mayor’s tests:
•    ADD2408: approval for expenditure of up to £20,000 
•    MD2799: approval for expenditure of up to £60,000
•    ADD2608: approval for expenditure of up to £15,000 
•    ADD2647: approval for expenditure of up to £25,000
•    ADD2664: approval for expenditure of up to £49,995
•    ADD2699: approval for expenditure of up to £25,000. 
 

2.1     The overall objective is to provide the Mayor with a systematic, objective and independent assessment of a major NHS service change proposal against his tests. This will enable the Mayor to determine the extent to which the tests have been met; and to identify where he w    ould like to see changes and improvements to the scheme, in order for it to better meet the tests. On this basis, the Mayor will seek to influence the development of these service changes to ensure that they: are in the best interests of all Londoners; and help to tackle health inequalities. 
2.2    The assessment conducted by the consultants will highlight positive evidence towards the tests being met; and areas where there is a lack of evidence of the tests being met. It will also critically assess key assumptions on which the proposals are based; and highlight any areas in need of further development or challenge. 
2.3     The assessment will form part of an overall briefing for the Mayor to inform his response to the proposed service change. The Mayor’s response, which will refer to the assessment, will be published on the GLA website. The Mayor’s response will be expected to result in positive changes being made to the proposed service changes, so that they better meet the needs of Londoners and tackle health inequalities.
 

3.1.    Reducing health inequalities underpins most of the health and wellbeing team’s work, including the Mayor’s tests. Health inequalities are differences in health that are unnecessary, avoidable, unjust and unfair. They often disadvantage groups of people with protected characteristics; people who experience poverty; and people who experience socioeconomic deprivation.
3.2.    Assessments against the Mayor’s tests include a specific focus on reducing health and healthcare inequalities. The first test  specifically aims to ensure that proposals: make the most of every opportunity to reduce health and healthcare inequalities; and set out an evidenced plan for further action. The assessment will enable the Mayor to champion and challenge the NHS accordingly. 
3.3.    This work aligns with the Mayor’s Equality, Diversity and Inclusion Strategy Objectives (2022). It particularly aligns with objective 12, which commits to address the reasons for health inequalities that cause some groups to experience poorer physical and mental health outcomes. The specific groups that will benefit from this spend will vary depending on the nature of the proposals. However, previous assessments have included people experiencing socioeconomic deprivation, and people from minority ethnic backgrounds.
 

4.1.    The procurement of consultants will be in accordance with the GLA’s Contracts and Funding Code. A transparent and open tendering process will be used.
Risks and issues 
4.2.    The timetable for the six-tests assessments is determined by the timelines of different NHS teams and organisations. This presents the risk that, if the NHS timelines are delayed, the timelines for the assessments will also be delayed. In mitigation, officers will ensure that consultants bidding for the contracts to conduct the assessments are aware of this risk, and can build appropriate flexibility into their delivery timelines. 
Links to Mayoral strategies and priorities
4.3.    This work contributes to the Mayor’s Health Inequalities Strategy, which sets out plans to tackle unfair differences in health to make London a healthier, fairer city. Applying the tests to major health service changes will promote the implementation of the Health Inequalities Strategy by helping to address London’s health inequalities; and reduce the number of years Londoners live in poor health. 
4.4.    There are no conflicts of interest to note for any of the officers involved in the drafting or clearance of this decision form.
 

5.1.    Approval is sought for the expenditure of up to £25,000 to procure expert consultancy services. These will provide an independent assessment of proposals to change NHS services against the Mayor’s test framework for major NHS service changes.
5.2.    This expenditure of up to £25,000 will be funded from the Mayor’s Six Tests programme budget in 2025-26.
5.3.    There is sufficient budget in the approved 2025-26 GLA budget to fund the expenditure of £25,000 from the Mayor’s Six Tests programme budget in 2025-26.
 

6.1.    The schedule for the assessment is as follows: