“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.

 
 
 
 

CityMetric is now City Monitor! Come see us at our new home

City Monitor is now live in beta at citymonitor.ai.

CityMetric is now City Monitor, a name that reflects both a ramping up of our ambitions as well as our membership in a network of like-minded publications from New Statesman Media Group. Our new site is now live in beta, so please visit us there going forward. Here’s what CityMetric readers should know about this exciting transition.  

Regular CityMetric readers may have already noticed a few changes around here since the spring. CityMetric’s beloved founding editor, Jonn Elledge, has moved on to some new adventures, and a new team has formed to take the site into the future. It’s led by yours truly – I’m Sommer Mathis, the editor-in-chief of City Monitor. Hello!

My background includes having served as the founding editor of CityLab, editor-in-chief of Atlas Obscura, and editor-in-chief of DCist, a local news publication in the District of Columbia. I’ve been reporting on and writing about cities in one way or another for the past 15 years. To me, there is no more important story in the world right now than how cities are changing and adapting to an increasingly challenging global landscape. The majority of the world’s population lives in cities, and if we’re ever going to be able to tackle the most pressing issues currently facing our planet – the climate emergency, rising inequality, the Covid-19 pandemic ­­­– cities are going to have to lead the way.

That’s why City Monitor is now a global publication dedicated to the future of cities everywhere – not just in the UK (nor for that matter just in the US, where I live). Our mission is to help our readers, many of whom are in leadership positions around the globe, navigate how cities are changing and discover what’s next in the world of urban policy. We’ll do that through original reporting, expert opinion and most crucially, a data-driven approach that emphasises evidence and rigorous analysis. We want to arm local decision-makers and those they work in concert with – whether that’s elected officials, bureaucratic leaders, policy advocates, neighbourhood activists, academics and researchers, entrepreneurs, or plain-old engaged citizens – with real insights and potential answers to tough problems. Subjects we cover include transportation, infrastructure, housing, urban design, public safety, the environment, the economy, and much more.

The City Monitor team is made up of some of the most experienced urban policy journalists in the world. Our managing editor is Adam Sneed, also a CityLab alum where he served as a senior associate editor. Before that he was a technology reporter at Politico. Allison Arieff is City Monitor’s senior editor. She was previously editorial director of the urban planning and policy think tank SPUR, as well as a contributing columnist for The New York Times. Staff writer Jake Blumgart most recently covered development, housing and politics for WHYY, the local public radio station in Philadelphia. And our data reporter is Alexandra Kanik, whose previous roles include data reporting for Louisville Public Media in Kentucky and PublicSource in Pittsburgh, Pennsylvania.

Our team will continue to grow in the coming weeks, and we’ll also be collaborating closely with our editorial colleagues across New Statesman Media Group. In fact, we’re launching a whole network of new publications, covering topics such as the clean energy transition, foreign direct investment, technology, banks and more. Many of these sectors will frequently overlap with our cities coverage, and a key part of our plan is make the most of the expertise that all of these newsrooms combined will bring to bear on our journalism.

Please visit citymonitor.ai going forward, where you can also sign up for our free email newsletter.


As for CityMetric, some of its archives have already been moved over to the new website, and the rest will follow not long after. If you’re looking for a favourite piece from CityMetric’s past, for a time you’ll still be able to find it here, but before long the whole archive will move over to City Monitor.

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I want to thank and congratulate Jonn Elledge on a brilliant run. Everything we do from here on out will be building on the legacy of his work, and the community that he built here at CityMetric. Cheers, Jonn!

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Sommer Mathis is editor-in-chief of City Monitor.