Posted on Oct 25, 2013 by Ruth Loftus
London retains a reputation as one of the world’s most exciting and even glamorous cities – one of the handful of places that draw talented and ambitious people from across the entire globe.
In the areas of finance, the media and technology, London maintains a genuine cutting edge. The metropolis seems to have recovered from the global downturn of half a decade ago more speedily than the rest of the UK and with a new vigour.
However, beneath the surface glitter the city and its people do have a deep rooted and continuing challenge to face with regard to healthcare. NHS England, the national body which aims to improve health provision and outcomes for people in England, has recently highlighted the degree of crisis which it sees growing in London. It actually claims that London’s hospitals are close to breaking point and projects that the service as a whole faces a shortfall in funding of some £4 billion by 2020. Part of this problem stems from an increased demand from a growing and ageing population and pressure from the central government which is constraining resources.
London’s specific healthcare challenges include:-
Rising life expectancy - This has increased by 5.2 years in little over two decades, a year more than the average across the country
A situation where some 80% of premature deaths arise from ‘lifestyle’ causes - particularly the consequences of alcohol and smoking, dietary deficiencies and poor exercise habits
Over 130,000 women have babies each year, and the birth rate shows an annual growth rate of around 3%
The population aged 65 and over is expected to grow by 19% by the end of the decade
20% of children are at a real risk of becoming obese
The Incidence of acute sexually transmitted diseases exceeds that of all other parts of England
NHS England says that simply building more in hospitals is not the answer. The need in healthcare is for a much greater focus on prevention rather than treatment; on the improvement of primary and community care services and on seeking to manage and deliver services closer to where patients live.
This approach reflects NHS England’s overall purpose which is to put health services’ patients and the wider public at the core of care and to encourage the widest participation in the NHS, treating people respectfully and putting their interests first. Furthermore, the intention of the NHS is to develop the essential insight needed to improve outcomes and ensure that no individual or groups of people are left behind or materially disadvantaged.
NHS England’s approach is seen as a vital component is underpinning and renewing public confidence in health care, which has been diminished by recent scandals that have highlighted how care and patient focus has been eroded in some hospitals.
The Kings Fund, an independent and highly regarded research body has also recently identified the threat of breakdown in some aspects of London healthcare. The institute was particularly damning with regard to recent reforms of which it claimed have led to an increase in the number of health organisations across the capital and the consequent risk of inconsistency and incoherence. Getting rid of primary care trusts, health authorities and their replacement by clinical commissioning groups, means that the organisation and operation of the NHS is now much more complex.
The Kings Fund argued that the situation in London – which was very different from that in the rest of England - means that a single body was essential to provide oversight of care in the City and that there was undoubtedly a need for urgent action. The KF also highlighted the specific financial aspects to this fast emerging crisis noting that of the five most financially challenged NHS trusts, four are in London and that these have a joint deficit of £120m. Consequently, the NHS in London may be at risk of becoming financially unsustainable without these radical changes in organisation.
The institute proposed a system of commissioning services for London based on a model developed in the United States for war veterans, whereby commissioning services would be overseen by a single strategic body with supporting networks of providers. They also argued that rules on mergers and competition in London needed to be revisited to avoid the time and money that went into reorganisation.
Their daunting view was that London's health system faces the risk of becoming unsustainable in financial terms and that patient care was increasingly at risk as the structures currently in place are not fit for the required purpose. Therefore, a radically different approach is believed to be required to bring about the necessary changes.
The crisis on the immediate horizon involves accident and emergency services across London which failed to meet targets for attending to patients during the summer months – when demand is generally lighter and so it is expected that these services will have a particularly challenging time in the coming winter.