“A sustainable NHS in London needs Londoners that are healthy”

A hospital, possibly in London. Image: Getty.

Labour’s London Assembly health spokesperson on NHS reform.

We need to think again before continuing with the largest experiment that London’s NHS has ever seen. This was the view that was reached this week by the mayor of London on the publication of the King’s Fund’s independent review of sustainability and transformation plans (STPs).

Deeply controversial across the capital because of their radical plans for hospital cuts and closures, STPs have become symbolic of an NHS unable to cope with the demand it faces from the public. In the face of growing demand, the NHS budget isn’t increasing at the same rate, with a £4.1bn shortfall expected to hit by 2021.

Partly driven by finances, the added challenge of Brexit runs the risk of adding to London’s high vacancy rates for medical professionals in almost all areas and specialisms. These are actual posts, budgeted for, that should be filled by doctors, nurses, midwives and allied health professionals, that aren’t filled because there are no qualified people available to fill them.

At the rate of demand, by 2021, London’s hospitals would need to provide an additional 1,700 acute beds. STPs plan to do precisely the opposite: reduce beds, “reconfigure” services, and in some circumstances close hospitals all together.

Whilst the focus on STPs promoting collaboration over competition within the health economy is a welcome shift in emphasis, the lack of system wide leadership and political accountability is damaging, rather than helpful in ensuring the entire health and social care world work together.


Cuts to local government funding and the growing instability of the care provider market have seen the rate of people staying in hospital longer than they need to because of the lack of availability of nursing or care home spaces, doubling since 2012. Over the same period 1,500 more Londoners spent 40,000 more days in hospital after they were medically discharged, because the rest of the system cannot cope with the pressures they face.

Without the kind of decisive leadership Strategic Health Authorities were previously able to provide, quite how the healthcare world will overcome these structural and financial barriers remains unclear. Quite who will be able to unlock the £5.7bn capital investment needed to bring STPs into fruition remains to be seen, leaving proposals open to the accusation that they are a “cut now, pay for it later” sticking plaster.

The crisis that the NHS faces is one of increasing clinical need. The true challenge to its sustainability isn’t the money available to plug the ever-growing financial black hole, but the very ill-health that drives people through the hospital door.

So much of that clinical need is preventable. Rather than forever tackling the consequences of ill-health, keeping people healthier for longer doesn’t just make financial sense, it’s the right thing to do. Despite the cuts to local government public health funding, bigger and better solutions are needed to prevent poor health in the first place.

Setting out this very case, the mayor has recently launched his strategy for tackling the unfair and avoidable health iniquity Londoners face, which sees people living in some parts of London spend nearly 20 years less enjoying good health. 

The strategy is heroic in its attempt to tackle complex social and economic injustices that allow poor health to go unchallenged. Starting at the earliest point, it recognises that the best way of ensuring Londoners lead healthy lives is to ensure our young people get the best possible start in life, and are supported to grow as healthy, resilient children at home, in school and around their communities.

By tackling the growing scourge of mental health problems like stress, anxiety and depression, it will attempt to ensure that the pressures of modern life won’t continue to act as a barrier for people to be able to live, work and enjoy their city.

Through ensuring our streets are walkable, the air breathable and neighbourhoods enable us to make healthy decisions, it will attempt to build a City where healthy living is by design rather than an afterthought. The mayor has ambitions to make London the Healthiest City in the World.

Whilst Londoners may lead busy lives, ensuring that everyone has access to affordable and healthy food; that quitting smoking is always the easier option; that we control our alcohol consumption and it does not control us, will be key in preventing the long-term consequences to ourselves and the NHS we could otherwise bring about.

Over the coming months, both the STPs plans to make the NHS sustainable, and the mayor’s plans to help Londoners lead healthy lives, will be tested. They may be seen at times to engage in their own tough and protracted battles, but they are two sides of the same coin.

After all, a healthy, sustainable NHS in London needs Londoners that are healthy.

Dr Onkar Sahota is a member of the London Assembly for Ealing & Hillingdon, a practicing GP in West London, and Labour’s London Assembly Health Spokesperson. He tweets as @DrOnkarSahota.

 
 
 
 

A growing number of voters will never own their own home. Why is the government ignoring them?

A lettings agent window. Image: Getty.

The dream of a property-owning democracy continues to define British housing policy. From Right-to-Buy to Help-to-Buy, policies are framed around the model of the ‘first-time buyer’ and her quest for property acquisition. The goal of Philip Hammond’s upcoming budget – hailed as a major “intervention” in the “broken” housing market – is to ensure that “the next generation will have the same opportunities as their parents to own a home.”

These policies are designed for an alternative reality. Over the last two decades, the dream of the property-owning democracy has come completely undone. While government schemes used to churn out more home owners, today it moves in reverse.

Generation Rent’s new report, “Life in the Rental Sector”, suggests that more Britons are living longer in the private rental sector. We predict the number of ‘silver renters’ – pensioners in the private rental sector – will rise to one million by 2035, a three-fold increase from today.

These renters have drifted way beyond the dream of home ownership: only 11 per cent of renters over 65 expect to own a home. Our survey results show that these renters are twice as likely than renters in their 20s to prefer affordable rental tenure over homeownership.

Lowering stamp duty or providing mortgage relief completely miss the point. These are renters – life-long renters – and they want rental relief: guaranteed tenancies, protection from eviction, rent inflation regulation.

The assumption of a British ‘obsession’ with homeownership – which has informed so much housing policy over the years – stands on flimsy ground. Most of the time, it is based on a single survey question: Would you like to rent a home or own a home? It’s a preposterous question, of course, because, well, who wouldn’t like to own a home at a time when the chief economist of the Bank of England has made the case for homes as a ‘better bet’ for retirement than pensions?


Here we arrive at the real toxicity of the property-owning dream. It promotes a vicious cycle: support for first-time buyers increases demand for home ownership, fresh demand raises house prices, house price inflation turns housing into a profitable investment, and investment incentives stoke preferences for home ownership all over again.

The cycle is now, finally, breaking. Not without pain, Britons are waking up to the madness of a housing policy organised around home ownership. And they are demanding reforms that respect renting as a life-time tenure.

At the 1946 Conservative Party conference, Anthony Eden extolled the virtues of a property-owning democracy as a defence against socialist appeal. “The ownership of property is not a crime or a sin,” he said, “but a reward, a right and responsibility that must be shared as equitable as possible among all our citizens.”

The Tories are now sleeping in the bed they have made. Left out to dry, renters are beginning to turn against the Conservative vision. The election numbers tell the story of this left-ward drift of the rental sector: 29 per cent of private renters voted Labour in 2010, 39 in 2015, and 54 in June.

Philip Hammond’s budget – which, despite its radicalism, continues to ignore the welfare of this rental population – is unlikely to reverse this trend. Generation Rent is no longer simply a class in itself — it is becoming a class for itself, as well.

We appear, then, on the verge of a paradigm shift in housing policy. As the demographics of the housing market change, so must its politics. Wednesday’s budget signals that even the Conservatives – the “party of homeownership” – recognise the need for change. But it only goes halfway.

The gains for any political party willing to truly seize the day – to ditch the property-owning dream once and for all, to champion a property-renting one instead – are there for the taking. 

David Adler is a research association at the campaign group Generation Rent.

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