NHS reforms have undermined London's healthcare system

The NHS reforms have created a 'leadership vacuum' in London's health services that threatens to seriously undermine patient care, according to healthcare academics.

Professor Chris Ham: new structures not fit for purpose
Professor Chris Ham: new structures not fit for purpose

With a host of new organisations created by the reforms, but no single body overseeing the whole system, the result is ‘confusion and incoherence’, says The King’s Fund.

In a report entitled Leading Health Care in London: Time for a Radical Response, the thinktank argues that the major changes urgently needed in the capital's healthcare system can only be implemented through a city-wide strategic approach.

It calls for the rules on NHS mergers and competition to be suspended in London to allow the necessary reconfigurations of services to be implemented quickly.

Chief executive Professor Chris Ham said: ‘We do not believe these new structures will be sufficient. They are not fit for purpose, given the financial and service pressures that the system is facing.

‘The last thing we need is another reorganisation but if the structures will not deliver in the necessary timescale, then we need to build on those structures to provide the leadership that’s required.’

The reconfigurations planned by Lord Darzi in his Healthcare for London strategy of 2007 were expected to be implemented by the NHS London SHA and PCTs. But since the government halted the programme in 2010, and then abolished SHAs and PCTs, there is no clear strategic leadership of the system, says The King's Fund.

London's health economy now includes 32 CCGs, 33 health and wellbeing boards, 33 local authorities, 33 local health watch organisations, 21 NHS trusts, 19 foundation trusts, and three commissioning support units.

The King's Fund argues that NHS England's London regional office should be given a city-wide planning role, working with CCGs on commissioning, while hospitals should be organised within the three existing academic science networks, working together with a mandate to deliver service change.

'This would also ensure that major changes to services are overseen by London's most experienced managers and clinical leaders,' said Professor Ham.

What do you think? Comment below or download the full report here.

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