Mayor of London, Sadiq Khan calls for bigger role in NHS in London
- Independent report raises concerns about the impact NHS’s partnerships with councils will have on hospital capacity
- Report also recommends that the Mayor plays leadership role in NHS’s future plans for London
- Mayor is seeking major reassurances from the NHS and the Government before he can support any changes to health services in London
Following recommendations from independent experts, the Mayor of London, Sadiq Khan, has today called for a greater role in providing oversight of the NHS’s future plans in the capital and has set out six key assurances needed from Government to ensure Londoners get the best healthcare possible.
A report published today by The King’s Fund and Nuffield Trust shows that greater city-wide leadership is needed to successfully implement the five local NHS Sustainability and Transformation plans (STPs) for London, which set out proposals for the future of health and care services.
Sustainability and Transformation Partnerships are plans for the future of health and care services in England. Five STPs have been developed in London, covering North West, North Central North East, South West and South East services.
In addition, the King’s Fund report outlines risks presented by the proposals including the potential impact on hospital capacity.
It recommends that the Mayor, in his capacity of chair of the London Health board, should play a leadership role and provide oversight of the STPs to ensure there is proper coordination across the capital and that the plans meet the needs of all Londoners.
Sadiq Khan has championed the NHS since the outset of his Mayoralty and today confirmed his willingness to provide the strategic leadership required. But, given the concerns raised in today’s report, combined with a potential gap of £4.1billion in NHS finances in London by 2021, the Mayor warned that before he will give support for any changes to NHS services in the capital the Government must provide key assurances.
The six assurances the Mayor requires to give his support to the STPs are:
- Patient and public engagement – Proposals must show credible, widespread and ongoing patient and public engagement including with marginalised groups.
- Clinical Support – Proposals must demonstrate improved clinical outcomes, widespread clinical engagement and support, including from frontline staff.
- Impact on health inequality – The impact of any proposed changes to health services in London must not widen health inequalities. Plans must set out how they will narrow the gap in health equality across the capital.
- Impact on social care – Proposals must take into account the full financial impact any new models of healthcare, including social care, would have on local authority services, particularly in the broader context of the funding challenges councils are already facing.
- Hospital capacity – Given that the need for hospital beds is forecast to increase due to population growth and an ageing population, any proposals to reduce the number of hospital beds will need to be independently reviewed to ensure all factors have been taken into account. Any plans to close beds must be an absolute last resort, and must meet at least one of the NHS’ ‘common sense’ conditions1.
- Sufficient investment – Proper funding must be identified and available to deliver all aspects of the STP plans.
Commissioned by the Mayor, the independent report is designed to ensure the STP proposals offer the best deal for London’s health service. They also outlines other ways in which Sadiq Khan can provide leadership on health, including:
- Working with the NHS to tackle workforce shortages and concerns about the impact of Brexit, already a top priority for the Mayor
- Developing London as a global leader in life sciences, a key part of City Hall’s skills remit
- Supporting changes in the delivery of NHS services – a key area the Mayor has sought assurance on, particularly around hospital capacity
- Making better use of the NHS estate by releasing unused NHS property to help with the capital’s housing crisis – something the Mayor has already championed with Met Police and TfL owned land
- Providing leadership in the prevention of ill health and on tackling health inequalities, including giving every child the best start in life, tackling obesity and improving air quality – key elements of the Mayor’s health inequalities strategy
Since the abolition of the Strategic Health Authority for London in 2012, there has been no similar pan-London leadership role in the capital. As chair of the London Health Board, the Mayor brings together the NHS, local authority leaders and Public Health England. The Mayor and partners have also been working with Government to push for greater devolution of health to London.
The Mayor has already taken steps to improve the health of Londoners, including the publication of a new strategy to reduce health inequalities in the capital2, the most ambitious plan to tackle air quality in any city in the world3 and the launch of Thrive LDN, a city-wide movement improve the mental health and wellbeing of Londoners4.
The Mayor of London, Sadiq Khan, said: “I want London to have a world-class health service and have promised to champion and challenge the NHS at all times to achieve this, and to make sure Londoners have access to excellent health and care services.
“Any plans around the future of NHS services in London must be given proper investment, and must not have an adverse impact on health inequalities, social care or hospital capacity. I also want every assurance that our heroic doctors, nurses and health and care professionals get all the support they need to realise these plans, and that Londoners and patients are properly consulted. By working together, with a city-wide vision, we can ensure that Londoners get the best healthcare possible.”
Chris Ham, Chief Executive of The King's Fund, said: "Patients can be reassured that the plans set the right direction for the future of health services in London, and the focus on preventing ill health, providing more services in the community and joining up health and social care is to be applauded. However, some of the financial assumptions underpinning the plans are questionable and proposals to reduce hospital beds are not credible. It is essential that NHS staff, local authorities, patients and the public are now involved in developing and implementing the plans. The Mayor has an important role to play by working with NHS and local authority partners to ensure care is effectively co-ordinated across the capital."
Nigel Edwards, Chief Executive of the Nuffield Trust, said: “The STP process has helped local organisations forge new relationships and set in train plans for reforming care that are long overdue. But our analysis finds that many of their assumptions about reducing the amount of hospital activity may be overly optimistic, given demographic and financial pressures.”
Notes to editors
1 NHS England’s newly introduces ‘common sense’ conditions are to provide:
Sufficient alternative provision (such as increased GP or community services) is being put in place ahead of bed closures and/or
Specific new treatments or therapies will reduce specific categories of admissions and/or
Where a hospital has been using beds less efficiently than the national average there is a credible plan to improve performance without affecting patient care
2The Mayor has published ‘Better Health for all Londoners’ - aiming to tackle city’s inequalities and improve the health of everyone living in the capital. www.london.gov.uk/health-strategy
3Sadiq has committed £875 million over the next five years to improving London’s air quality, and will introduce an Ultra-Low Emission Zone (ULEZ) in April 2019 (subject to consultation), which will see the capital’s most-polluting vehicles charged for driving within central London. Poor air quality contributes to over 9,000 premature deaths in London annually and is more concentrated around schools with a higher proportion of children who receive free school meals, meaning poorer families are disproportionately affected by air pollution.
4In order to improve mental health and wellbeing across the capital, the Mayor launched Thrive LDN – a new city-wide movement that will support the two million Londoners that experience mental health problems every year. People will severe mental illness have a much lower life expectance than the rest of the population and two Londoners a day take their own lives.
- Sustainability and Transformation Partnerships (STPs) are plans for the future of health and care services in England. Five STPs have been developed in London, covering North West, North Central North East, South West and South East services. The King’s Fund and Nuffield Trust reviewed the content of London’s STPs to identify their key themes and analyse the proposals being made.
- The full report can be viewed here:
- The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.
- The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
- London Health Board is made up of:
- Sadiq Khan, Mayor of London
- Cllr Kevin Davis, Leader, Royal Borough of Kingston Upon Thames
- Cllr Denise Hyland, Royal Borough of Greenwich
- Cllr Richard Watts, London Borough of Islington
- Dr Anne Rainsberry, NHS England London Region
- Dr Marc Rowland, Londonwide Clinical Commissioning Council
- Prof Yvonne Doyle, Public Health England, London Region
- Claire Murdoch, Cavendish Square Group (on behalf of London’s mental health trusts)
- Daniel Elkeles, Epsom and St Helier University Hospitals NHS Trust (on behalf of London’s NHS trusts)