London NHS in crisis

MQT on 2014-11-19
Session date: 
November 19, 2014
Question By: 
Onkar Sahota
Labour Group
Asked Of: 
The Mayor


Recent figures show that the number of ambulances in London meeting their target response time has decreased significantly in the last six months. Further to this, reduced access to GP services in London is creating increased pressure on our A&Es. What representations are you making on these issues?


Answer for London NHS in crisis

Answer for London NHS in crisis

Answered By: 
The Mayor

Boris Johnson (Mayor of London):  Thank you, Onkar.  This is a very relevant question and one that Victoria [Victoria Borwick AM, Deputy Mayor of London] and I have been thinking about a great deal in the last few months.  Everybody is aware that the London Ambulance Service (LAS) does a fantastic job but it is under colossal pressure.  It basically does not have enough paramedics.  It has a rising volume of calls.  It has very, very serious problems.  I, as Mayor, cannot ignore that, even though of course I do not directly run the ambulance service.  We have had lots of conversations with Ann Radmore [Chief Executive, LAS] and have also written to Jeremy Hunt [Secretary of State for Health] with Ann’s encouragement to try - you will have to forgive me, I am not very well - to set out our concerns.  We are in contact with NHS England’s London Director to try to tackle the waiting times in A&E departments, including by improving GP and community services.


There are many factors that are causing the difficulties in the ambulance service and many solutions are now being adopted, including trying to recruit urgently the paramedics that they need.  Forgive me, I think I am going to have to go and take a break. 


Roger Evans AM (Chairman):  Do you want to take a moment just to compose yourself?


Boris Johnson (Mayor of London):  Yes.  Will you forgive me if I go and have a drink?  I will be back.  Take it out of my time.


Roger Evans AM (Chairman):  Can we just adjourn the meeting for a moment while the Mayor recovers?  This is turning into quite a long session.


Boris Johnson (Mayor of London):  Sorry, Roger.  I have a bad cold.




Roger Evans AM (Chairman):  Are you feeling better?


Boris Johnson (Mayor of London):  I am.  I just did not want to keep spluttering while I am trying to answer Onkar [Sahota] about health.


Roger Evans AM (Chairman):  We quite understand.


Boris Johnson (Mayor of London):  Forgive me, Onkar.


Victoria Borwick AM:  Mr Mayor, we are just welcoming Charlton Manor, which was the first school in London to receive the Gold Healthy School Award.


Boris Johnson (Mayor of London):  Well done.


Roger Evans AM (Chairman):  I am just going to resume the meeting because this is being recorded.  Carry on.


Boris Johnson (Mayor of London):  Anyway, I have more or less finished my answer.  Onkar?


Dr Onkar Sahota AM:  Mr Mayor, I know that you have just come back from New York and you may not have caught up with all the headlines in this country.  The headline of the Mail on Sunday was the A&E closures are in meltdown.  This is something I have been warning about for the last two years and so has the Mail on Sunday.  We have a situation where you cannot get an ambulance in time, people are waiting.


Boris Johnson (Mayor of London):  Where what?


Dr Onkar Sahota AM:  We have a situation that the ambulances cannot reach their own target.  Their target is they should reach the caller within eight minutes 75% of the time and they are only hitting the target 62% of the time.  Moreover, if you look at Northwick Park and the A&E at the Ealing Hospital, they do not see the patients 30% of the time within the target and it should be below 5%.  Further, another hospital randomly I am looking at is Hillingdon Hospital and it does not see the patients 21% of the time within the target, although they are meant to see 5%.  They are meant to see 5% outside the four hours but they only manage to see 21%. 


What I am saying is we have an A&E meltdown crisis.  We have a crisis in the ambulance staff.  You cannot get an appointment with GP services.  What are you doing about it?


Boris Johnson (Mayor of London):  On the A&E crisis and the difficulties A&Es are having, we have written to and sought assurances from NHS England that they are trying to get back up to the 95% waiting times standard.  We are on that. 


The difficulty, as you know very well, Onkar, as a GP, is that London has a shortage of GPs and indeed of effective GP cover in my view.  You will be familiar with some of the arguments that have raged in London over the last few years about how to deal with that.  We should be encouraging more GPs but we should also in my view have gone down the route of having more, whether you want to call them cottage hospitals or polyclinics or however you want to describe them, walk-in centres.  That was the right thing for our city to do.  It was a great shame that that was all dropped, as I remember, by Labour when [Lord] Ara Darzi [Chair, London Health Commission] produced ages ago what I thought was a very credible solution.  It is very sad that we have not gone forward with that. 


The problem with primary care and GPs is feeding through into the A&E problem.  It has been compounded by the shortage of paramedics.  It is not just the shortage, of course.  The big change that happened was that the paramedics - I am looking at Victoria [Borwick AM, Deputy Mayor] to prompt me here - was that the paramedics’ qualification became applicable not just for the ambulance service but for all sorts of other jobs.  Suddenly they were being sucked away to do all sorts of employment other than working in the ambulance service.  The result is that there is a huge shortage of paramedics, to the point now where we had to recruit in Australia for 180 London Ambulance Service paramedics.  You will appreciate--


Dr Onkar Sahota AM:  Mr Mayor, the question was that the population of London is going up.  We cannot recruit the paramedics.  The answer is not to close A&E departments.  You set up the London Health Commission and you mentioned Lord Darzi and he called upon you to call together the decision-makers in London.  He called upon you to make a case for a £1 billion investment in the community service over the next five years.  What are you doing about it?  How are you taking the findings of the London Health Commission?


Boris Johnson (Mayor of London):  Unfortunately, as you know, I do not run the ambulance service.


Dr Onkar Sahota AM:  Part of the problem, Mr Mayor, is that we do not know who is running it.  The whole thing is all fragmented.  Who is running the LAS?  That is part of the problem.  We do not know who is running it.


Boris Johnson (Mayor of London):  I would love to do it. 


Dr Onkar Sahota AM:  You are not running it.  The Secretary of State is not running it.  Who is running it?


Boris Johnson (Mayor of London):  No, the Secretary of State is running it. 


Dr Onkar Sahota AM:  No, they are not. The GPs have no choice in the matter at all.


Boris Johnson (Mayor of London):  As you know, we do not have control of the budgets, but clearly there is a problem.


Dr Onkar Sahota AM:  I know you have been dealt with a bad hand, Mr Mayor.  You have been dealt a bad hand of cards by the Secretary of State, but you need to stand upright and show leadership.


Boris Johnson (Mayor of London):  I am very happy to.


Dr Onkar Sahota AM:  ‑The leadership you referred to in the Churchill book.  The same leadership is required here on the NHS.  


Boris Johnson (Mayor of London):  Thank you for another plug.  I cannot fault the Assembly this morning for the generosity you have shown in mentioning this book.


Dr Onkar Sahota AM:  Walk the talk.


Boris Johnson (Mayor of London):  We have intervened on all the issues that you mention.  Onkar, you should be in possession of the correspondence.  It is very frustrating because it would be a huge advantage to London if primary care was basically devolved to London, be it at borough level or with a strategic role for the GLA.  That is basically what should happen.  There is a natural fit between social services and primary care.  It would give the boroughs much more control and you would have genuine local democratic responsibility.  You might get some good decisions.  You might get some braver decisions because at the moment you have national politicians who are absolutely terror-stricken about taking difficult decisions, if we are honest about some of these issues.  Yes, they are terror-stricken because they are wrong.  Only [John] Biggs has a totally wrong line on the airports.


If you look at healthcare and hospital provision, many of the arguments are very similar, in my view, to some of the arguments that you hear about ticket offices or fire stations or police stations.  People have too much of an attachment to bricks and mortar and not enough attachment to excellent services.  You could have reforms that benefited healthcare and increased longevity right through the city.  I am a passionate believer in devolution, not just fiscally but in healthcare as well.


Dr Onkar Sahota AM:  Thank you, Mr Mayor.