ADD2408 Analysis of hospital reconfiguration proposals

The Mayor has committed to champion and challenge the NHS on behalf of Londoners, and this is identified as a mayoral priority for health in MD2439.

In 2017, in response to a report commissioned by the Mayor into London’s five Sustainability and Transformation Plans (approved under ADD2067), the Mayor announced six ‘tests’ he expected to be met before he gave his support to any major health and care transformation or hospital reconfiguration proposals in London. These tests cover:

• health inequalities and the prevention of ill health;
• hospital bed capacity;
• financial investment and savings;
• impact on social care;
• clinical support; and
• patient and public engagement.

Approval has already been given under ADD2428 (December 2019) to commission a single report into London’s Sustainability and Transformation Partnership (STP)/Integrated Care System (ICS) system-wide plans.

This ADD is seeking approval to procure expert external consultancy services up to the value of £20,000 to prepare assessments of major hospital reconfiguration proposals launched for public consultation in 2019/20, against the Mayor’s six tests.

The NHS timetable for the publication of upcoming hospital reconfiguration proposals is not fixed and it is therefore difficult precisely to predict the volume of work that will be needed during this period. The maximum value of the procurement is based on the likely number of proposals and their level of complexity. Following a competitive procurement process, a single supplier framework agreement will be established with the winning bidder. The GLA will have the flexibility to call off from the framework as and when required and be able to achieve best value for money without the need to repeat the competitive tendering process.

The overall objective is to provide the Mayor with systematic, objective and independent assessments of individual major hospital reconfiguration proposals against his six tests; these will help him to determine the extent to which the tests have been met, and to champion and challenge the NHS accordingly on behalf of Londoners.

For each set of hospital proposals, consultants may be asked to provide an assessment against all six tests or a subset of them.

For each test the consultants will highlight positive evidence towards the test being met, as well as areas where there is a lack of evidence. They will also critically assess key assumptions on which the hospital reconfiguration proposals are based and highlight any areas in need of further development and/or challenge.

These assessments will form part of an overall briefing for the Mayor to inform his response to individual hospital reconfiguration proposals. They will be published on the GLA website alongside the Mayor’s responses.

Reducing health inequalities underpins most of the health team’s work, including the Mayor’s six tests. Health inequalities are differences in health that are unnecessary and avoidable, as well as unjust and unfair. They often exist between groups of people with protected characteristics , and those who experience poverty and socioeconomic deprivation .

This project includes a specific focus on reducing health inequalities, with the first test specifically aiming to ensure that proposals consider the potential imp act on inequalities, don’t widen the inequality gap, and where possible reduce inequalities . The assessments will enable the Mayor to champion and challenge the NHS accordingly.

Alignment with the Equality, Diversity & Inclusion Strategy

In addition to aligning with the Mayor’s Health Inequalities Strategy, it is well aligned to his Equality, Diversity & Inclusion Strategy, particularly in relation to the objectives to make London a safe and healthy city. Objective 33 in the EDI Strategy is “to lead, and help coordinate, work to understand and address health inequalities and support at-risk communities to increase their health skills, knowledge and confidence”. The Mayor’s six tests are an important tool for the Mayor to use to lead and coordinate action to reduce health inequalities.

Risks and issues

The NHS timetable for the publication of upcoming hospital reconfiguration proposals is not fixed and it is therefore difficult precisely to predict the volume of work that will be needed during this period. Health team officers will maintain close contact with the NHS in London to ensure early notice of plans to publish proposals. Following a competitive procurement process, a single supplier framework agreement will be established with the winning bidder. The GLA will have the flexibility to call off from the framework as and when required and be able to achieve best value for money without the need to repeat the competitive tendering process.

Links to Mayoral strategies and priorities

This work has links to the Mayor’s Health Inequalities Strategy (HIS), which sets out plans to tackle unfair differences in health to make London a healthier, fairer city. Health inequalities are inexplicably linked to other types of inequality. This is because they are most often a direct result of inequalities in other areas of life, i.e. socioeconomic differences. The Strategy outlines key actions to address the socio-economic causes of poor health (social determinants).

Applying the six tests to major service reconfigurations will promote the implementation of the health inequalities strategy and will contribute towards the ambition to address London’s stark health inequalities and to reduce the number of years Londoners live in poor health.

There are no conflicts of interest to note for any of the officers involved in the drafting or clearance of this decision form.

Approval is being sought for expenditure of up to £20,000 for the procurement of expert consultancy services to assess major hospital reconfiguration proposals against the Mayor’s six tests.

As the NHS timetable for the reconfiguration proposal is not fixed, this is causing uncertainty within this external assessment project timeline. Therefore, expenditure could slip into next financial year (2020-21). This will be managed by the Health Team, if delays occur.

This expenditure will be funded by the Communities & Intelligence Minor Programme budget for 2019-20.

*This will be determined by the NHS timetable for each hospital reconfiguration, including the formal public consultation period and subsequent publication of the consultation report and revised business case.