BMJ 2013;347:f6243 doi: 10.1136/bmj.f6243 (Published 15 October 2013)

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NEWS London’s health services need radical change, says NHS England Jacqui Wise London

London’s hospital system is at breaking point, and demand for healthcare will outstrip funding in seven years unless there is a fundamental change in the way services are delivered, NHS England’s regional medical director for London, has warned.

cardiovascular surgery. Centralisation of stroke and trauma services has also saved hundreds of lives in London, the report says.3

The report is the London version of the national call to action launched by NHS England’s chief executive, David Nicholson, in July.2 NHS England said that the analysis would be useful to stimulate debate about the challenges facing healthcare in London. Discussions will be led by London’s clinical commissioning groups, working with health and wellbeing boards.

The report makes the case for closing some smaller hospitals and units in London. It says that London’s hospital services are becoming increasingly unsustainable, clinically and financially, and in many cases are no longer fit for purpose. It says that the average catchment population of London’s acute hospitals is around 265 000, lower than those in other regions in the country, with wide variation between very large and much smaller sites.

Andy Mitchell gave the warning at the launch of a report, London: A Call to Action, which argues that health inequalities and an ageing population mean that the existing model of NHS healthcare is unsustainable in the capital.1

But London does badly on cancer treatment: there are poor rates of early diagnosis of cancer, with around one in three cancer diagnoses made in hospital emergency departments; and of the 10 hospitals rated worst for cancer patients’ experience of care, nine are in London.

Anne Rainsberry, NHS England’s regional director for London, said that there was likely to be a £4bn (€4.7bn; $6.4bn) shortfall in London by 2020. “Investing more in hospitals is not the answer. We need to focus more on prevention and improve our primary and community care services to coordinate services closer to where patients live,” she said.

Mitchell said, “We need to rethink where and how services are provided around the needs of patients—not the needs of healthcare professionals or around individual institutions. It is time to start listening to leading doctors and nurses about how we can adapt and change if the NHS is to survive. This will mean some difficult decisions need to be made.”

The report says that primary care needs to be transformed so that services are more accessible and responsive. Rates of patients’ satisfaction with primary care are 7% lower in London than nationally. This finding highlights the fact that London has a larger proportion of single handed practices than elsewhere in the country, ranging from 5% to 40% across London’s clinical commissioning groups. The report says that improving access and meeting the public’s expectations will be difficult unless this model of delivery was changed.

London faces a number of challenges. Its population of more than 8.2 million people is growing at a faster rate than any other region in England. There is a rising birth rate, and the number of Londoners aged 65 or over is set to rise by 19% by 2020. The prevalence of childhood obesity is higher than the national average, and a fifth of London’s children are at risk of becoming obese. The incidence of acute sexually transmitted diseases is higher in London than in any other region. The report says that important improvements have been made in the capital. For example, life expectancy in London has risen by 5.2 years since 1990, a year longer than the national average, but life expectancy varies widely between boroughs. It says that consolidation of cardiovascular services has resulted in London now having one of the country’s lowest rates of death after For personal use only: See rights and reprints http://www.bmj.com/permissions

But John Lister, director of the campaigning group London Health Emergency, criticised the report as alarmist. “This is not a health crisis but a financial crisis,” he said. “The problem has been entirely manufactured by unrealistic government spending limits as they slash public services to pay back the billions used to bail out the banks.” Londoners who want to get involved in the debate should contact their local clinical commissioning group or complete a survey on www. myhealth.london.nhs.uk. bmj.com Editorial: Leading healthcare in London: time for a radical response? (BMJ 2013;347:f4711, doi:10.1136/bmj.f4711); News: Suspend NHS competition rules in London to allow for urgent remodelling of healthcare, says think tank (BMJ 2013;346:f4120, doi:10. 1136/bmj.f4120) 1 2 3

NHS England. London: a call to action. Oct 2013 https://www.myhealth.london.nhs.uk/ sites/default/files/u78/London%20-%20A%20Call%20to%20Action%20%28final%29.pdf. Kmietowicz Z. NHS in England needs new strategy to avoid £30bn shortfall, say health chiefs. BMJ 2013;347:f4507. Hawkes N. Streamlined stroke services in London save lives and money, study finds. BMJ 2013;347:f4954.

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BMJ 2013;347:f6243 doi: 10.1136/bmj.f6243 (Published 15 October 2013)

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London's health services need radical change, says NHS England.

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