“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.

 
 
 
 

You’ve heard of trainspotters and planespotters. Now meet Britain’s growing army of busspotters

Some busspotters in action. Image: Damian Potter.

In the summer of 2014, with too much time on my hands and too little to do, I found myself in the middle of an incredibly active, 200+ person Facebook group. How I ended up here (record scratch, freeze frame) is a little too convoluted and stupid to explain – but what I found was a world that I a) could not have imagined nor b) had any clue even existed.

The group I tumbled into was what I now understand to be a very, very small example of a “busspotting” group – that is, a Facebook group full of dedicated bus enthusiasts which exists to share pictures of buses they see on the road. This group had members from all over the country, with a concentration on northern buses, and was predominantly filled with young, white men.

What I expected to see was a range over relatively interesting buses, holding some significance or another, that were tough to find in your average day-to-day life. This was, largely, not the case. What fascinated me was that the vast majority of the group was not focused on unique buses, new buses, historically significant buses, and so on – but simply on the average bus and or bus route you might take just to get around your city.

What was even more bizarre to me was that people from across the country were meeting up in small towns (Morpeth, Livingston, Stevenage) to take seemingly mundane bus rides to other equally small places (Washington, Gloucester, Grimsby). The busspotters would travel hours on end to meet at these locations simply to ride this bus, often for three or four hours, and experience a bus route they’d never been on before or one that they just particularly enjoyed.

Ooooh. Image: Damian Potter.

After a couple of weeks of silently watching and one semi-ironic post, I left the group. And, for the next three years, I gave barely a thought to bus enthusiasm, as no busspotter group/page/person crossed my path. Unlike similar enthusiasms like planespotting and trainspotting, it didn’t seem to me that busspotting had any significant following.

But, as is the way of these things, a weird thread on Twitter three summers later sparked my memory of my short time in this group. I wanted to see what busspotting was actually and about and if, in fact, it was still a thing.

So I spoke to Damian Potter, an admin on several popular busspotting groups, about what it’s like to be deep into the busspotting scene.

“I used to sit upstairs on double decker buses and 'drive' them, including the pedal movements!” Damian announced right off the bat, speaking of his childhood. “I've been driving coaches at home and abroad since I passed my PCV test in 1994. I've been driving for Transdev Harrogate and District Travel since 1998.”

Damian, as you might have gathered, has been a busspotter since his early youth. Now, at the age of 50, he manages four different busspotting Facebook groupsm, mostly based around the Harrogate area (Transdev Enthusiasts, The Harrogate Bus Company, iTransport Worldwide and Spotting Bus and Coach Spotters). Some of them have over a thousand members.

He also participates in busspotting IRL, travelling around the country participating in busspotting meet-ups and events and co-organising trips along different bus routes. When I asked him what busspotting was to him, he explained that it can manifest in different ways: some people focus on makes of bus and routes, other focus on particular bus companies (National Express is particularly popular). Of course, bus enthusiasm is not solely a British phenomenon, but busspotters can certainly be found in practically every corner of the UK.

“People tend to think that spotters hang around bus stations furtively, with a camera and some curly cheese sandwiches, but this isn't really the case,” Damian continued. That said, he also mentioned some particularly hardcore bus nuts who have been known to trespass on company premises to be the first to snap a picture of a new bus.

“They really do produce some brilliant pictures, though,” he added.


Although much of busspotting culture happens online, predominantly on Facebook, groups often have what are called ‘running days’ which involve meet ups having to do with particular routes. Damian mentioned one particularly popular day following the London Routemaster buses that happen periodically. Not only do these routes draw in enthusiasts, he noted, but also draw huge numbers of tourists who want to claim they’ve ridden on the original London buses.

“I reckon the general public miss the old Routemaster buses. There is only one 'heritage' route in London which still uses Routemaster buses and that's the 15 service between Trafalgar Square and Tower Hill.”

Despite this widespread interest in buses and bus history, though, busspotters often find themselves treated as the lesser of the motor enthusiasts. This became clear to me almost immediately when speaking to Damian, and continued to strike me throughout our conversation; without my saying anything sarcastic, malicious, or snarky, he became instantly defensive of his fellow enthusiasts and of his hobby.

When I asked him why he felt this immediate need to defend busspotting, he explained that people often ridicule busspotters and bus enthusiasm generally, arguing that bus drivers are the most common attackers. “However,” he noted, “if I bring a load of pictures into the canteen they're the first to crowd around to see bus pictures...”

Aaah. Image: Damian Potter.

Despite being perceived as an often-mocked hobby, bus enthusiasm is expanding rapidly, Damien claims. “The bus enthusiast culture is growing, with younger generations getting more involved.” Drawing in new, younger enthusiasts has become easier thanks to social media, as has creating real personal connections. Social media has made it easier for bus enthusiasm to not just stay afloat, but actually thrive over the last several years.

It’s so widespread, in fact, that a national competition is held every year in Blackpool to mark Bus Driver of the Year (Damian himself came in 34th out of 155 back in 2002). This event draws in everyone from the bus world – drivers, manufacturers, tour companies, and enthusiasts alike. Here is one of the many places where great friendships are forged and busspotters who’ve only known each other online can finally meet face-to-face. “Personally I have made some great friends through Facebook,” Damian told me. “I have even stayed over at a friend's house in London a couple of times.”

Busspotting may be less well-known than motor enthusiasms like planespotting and trainspotting, but that very well could change. Thanks to active social media groups and regular in-person meet-ups, people have been able to use busspotting forums as not only a way to find lifelong friends, but also spend more of their free time exploring their hobby with the people they’ve met through these groups and pages who share their enthusiasm. For all the flack it may receive, the future of busspotting looks bright.

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