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.