NHS in London

London faces a number of health challenges including high rates of child poverty and an obesity rate that is higher than any other region of England; London’s leading causes of premature death are predominantly as a result of lifestyle factors. Mental illness and homelessness are also more prominent than elsewhere.

The State of London’s Health published in October 2015 (see Appendix to Better Health for London: One Year On, October 2015) sets out some of London’s current challenges: London is growing at a faster rate than any other region in England, with the population expected to increase to 10.1 million by 2041. London also has a transient population with 37 per cent of England’s short-term residents. This affects primary care as London GPs experience a 20 to 40 per cent turnover in their patient lists each year. London has wide inequalities in healthy life expectancy between and within London boroughs. Nearly 25 per cent of all Londoners are under 25 and these younger citizens need particular investment in ‘upstream’ prevention to avoid or delay ill health and disability later in life. But London also has a growing number of older people. By 2031, there will be a 40 per cent increase in over 80 year olds – the biggest users of health and care services.

The organisation of health services has also undergone major changes in recent years. Service reconfigurations have taken place or are in progress across London. These reconfigurations have included a reduction in the number of hospitals providing accident and emergency (A&E) services, acute medical, surgical and paediatric care, and obstetric-led maternity services, and the concentration of specialist services and surgery. While hospital reconfigurations are always politically controversial proposed service changes in North West London (Shaping a Healthier Future) and South East London have met with particularly strong opposition, including from local councils.

With the abolition of the London Strategic Health Authority and Primary Care Trusts in April 2013, NHS England’s London Regional Team delivers its commissioning responsibilities for specialist health services and primary care. London’s 32 Clinical Commissioning Groups are responsible for commissioning the majority of the capital’s healthcare, and have a combined annual budget of over £10 billion. In terms of NHS providers in London there are 16 acute NHS trusts, three mental health trusts, two community trusts, 18 NHS foundation trusts and a single London Ambulance Service.

London’s 33 local authorities are responsible for commissioning public health and social care services and work jointly with partners including CCGs, Public Health England, and the Mayor of London to take measures to improve the health of Londoners.

In September 2013, the Mayor of London launched a London Health Commission. Chaired by Professor Lord Ara Darzi, the Commission lasted a year and gathered evidence from the public, community groups and the private sector, and across the NHS and local government in the capital. (Further information can be found on London Health Commission website and in London Councils' evidence to the Commission).

In October 2014, Lord Darzi published his report Better Health for London. It sets out a series of aspirations and recommendations to a range of organisations across London and nationally to improve the health of Londoners and the quality of health and care services in the capital, as well as increasing the economic contribution of health and life sciences.

In March 2015, the Mayor of London, London Councils, NHS England (London), London's CCGs and Public Health England (London) published the Better Health for London - Next Steps Plan. In this report the partners in what are known as the London Health Board jointly committed to 10 aspirations to improve health and wellbeing in London, aiming to make London “the healthiest global city”.

Another report in March 2015, from London’s 32 CCGs and NHS England (London) set out their plans to make London the world’s healthiest global city. In a joint report, Transforming London’s Health and Care Together, they launched 13 “transformation programmes” to improve healthcare in the capital. The programmes include the development of a new way of working for GPs (further information can be found in Transforming Primary Care in London: a Strategic Commissioning Framework, March 2015)

In October 2015 the London Health Board partners published Better Health for London: One Year On , which set out progress on London's blueprint towards becoming a healthier city. To support this, London Health Board partners are seeking devolution from government and national bodies. On the 15 December 2015 the Chancellor signed a health devolution agreement with the London partners that set out shared objectives and principles, as well as a programme of work, to support the transformation of health and care in London.