Strategic Health Authority

Plenary on 2014-06-18
Session date: 
June 18, 2014
Question By: 
Onkar Sahota
Labour Group
Asked Of: 
Lord Darzi, Chair of the London Health Commission


Do we need a London Strategic Health Authority to give leadership and co-ordinate health services across London to address the health needs of London’s diverse population?


Answer for Strategic Health Authority

Answer for Strategic Health Authority

Answered By: 
Lord Darzi, Chair of the London Health Commission

Professor the Lord Darzi (Chair, London Health Commission):  If I could just revisit the past for a second and how the Strategic Health Authority was created, I actually did the London Framework for Action in 2006/07.  Then there were five Strategic Health Authorities that merged into one. 


London is a very, very different place now from where it was in 2006 and 2007.  To be fair, the Strategic Health Authority did drive and provide the leadership in some major changes at the time.  If you look at stroke care, 200 lives a year were saved by having the eight comprehensive stroke centres.  Most of the impact areas have been around the centralisation drivers at the time.  We are in a completely different era seven years later.  That is one.


The second is, you know this, because I led a major review when I had the privilege when I was in office 2008-9 which was High Quality Care for All.  I am one of these guys who strongly believes that if you really want to drive change, focus on transformational change rather than structural change.  Throughout governments we have seen structural change.  I gave you an example during 2006/07 when five Strategic Health Authorities became one.  We had 350 Primary Care Trusts (PCTs) and they became 135.  Then we move back again to no Strategic Health Authority.


We should really park this on the side and look at how we get cohesive leadership in London.  How do we get the three major actors in London; the local government, CCGs and NHS England, to come together and commission services based on the needs of the patients?  Most of the demand, and as the patient segmentation work suggests, is mostly about care nearer to the patient within the primary and community setting.  That needs local engagement.  You cannot have someone higher up there sending commands down saying, “Shift there”.  That is my own thoughts and views about this. 


What is missing is that engagement with the patients, the public and the clinicians.  It is that social mobilisation that has been missing.  I hope with the Commission we can get that up and really drive this change.  Again, we have seen elements of that.  If you look at the submissions, people are desperately keen to be heard, to be given the opportunity of making change happen.  That is where I stand on that. 


Dr Onkar Sahota AM:  Lord Darzi, you talk about this huge agenda for transformational change, therefore leadership must be an enabler of this. 


Professor the Lord Darzi (Chair, London Health Commission):  Absolutely.


Dr Onkar Sahota AM:  I was more concerned about the idea of giving strategic leadership across London rather than what you could call the body, to bring together this force that is needed.  I am a practising GP and I am at the sharp end and not just sitting in a NHS England office somewhere; I see patients. 


We now have 32 CCGs in London.  We have public health sitting in NHS Public Health and also local authorities.  I see people’s care getting fragmented rather than being fully integrated.  I really want to ask how you think there is a mechanism for improving the patient journey.  The patient is already concerned about getting the right care, the right place, right time, every time.  How do we make that change right across London?  We have issues of patients living in Ealing.  If they are registered with a GP in Ealing they cannot get care there if they live in Hounslow, for example.  Those sorts of boundary changes are really impacting on this and we have a new agenda across London.  How do we get us all together?


Professor the Lord Darzi (Chair, London Health Commission):  To be fair I have heard these challenges, not from you, from others who produced the evidence and submitted the evidence.  Is the answer the creation of another big bureaucracy?


Dr Onkar Sahota AM:  No.


Professor the Lord Darzi (Chair, London Health Commission):  I do not think that ticks the box.  I think what we need to do is give these organisations time of maturity, number one.  Number two is how could we drive the cohesive leadership between these different organisations?  There is a mind-set, whenever you create an organisation or structure, of silo  working.  Unless we are going to get local government, health and wellbeing boards, CCGs and also primary care commissioning ‑‑ I think you talked about airports this morning.  You have to commission the whole journey.  You cannot just say, “This is the guy building the planes.  This is the guy doing the things and we are going to do it separately”. 


The leadership that is required is to bring people at a local level and start really thinking about how we commission services based on what the patients need.  As I say, I have four months to go.  As it stands at the moment I do not have the evidence that we need another bureaucracy.  We may, however, look at the different organisations and say, “What do you need to fill the gaps?”  I remember famously four or five years ago when I was on one of my tours around, people kept saying, “Stop looking up.  Just look out towards the patient.  They will tell you where you should be heading”.  I think that is the mind-set change that is required at a local level.  For the Commission, what are the enablers to bring them together?


Dr Onkar Sahota AM:  The other thing, looking at the patient, you talked about what the patient wants.  They want to have longer appointments.  They want to have care given near their home.  They want to be able to have continuity of care.  This requires two things.  It requires, as you have already touched on, the estates. 


Professor the Lord Darzi (Chair, London Health Commission):  Correct.


Dr Onkar Sahota AM:  Secondly, it requires human resources, the doctors, the nurses to give this care.  We also know that we have investment in primary care of only 8% and we need to do more.


The mantra has been so far, keep the patients out of the hospitals, save the money and then we will invest money in primary care.  I was in a discussion about co-commissioning.  One of the arguments being put forward for co-commissioning was to release money from the hospital budget so we could make investment in primary care.  What we really need to do is, of course, catch up on this game.  Who is going to enable that shift in investment into primary care?


Professor the Lord Darzi (Chair, London Health Commission):  Absolutely.  I take your point.  I think there are some pan-London, even national, things that need to be addressed here.  NHS England has a very important role to play here in terms of ‑‑ talking about the estate, for example.  The estate issue cannot be resolved by the local borough and the CCG without a very clear set of proposals that we need to think through within the next four months and say, “We need a better disposal of estate.  We need better investment in estate.”  NHS England also needs to hear there is a significant challenge with their expectations of primary care provision if we are spending 8% on estate.  There are very clear sets of proposals that only NHS England has to address and deal with. 


Let us not forget there is also the GLA and mayoral moral pressure, per se, not necessarily legislative powers, but how he could at least speak for London’s health is the purpose of this document.


I agree with you, none of these big things could be done at a local level.  NHS England needs to address those. 


Dr Onkar Sahota AM:  Thank you.