Dr Tom Coffey, 22 February 2021
Coronavirus (COVID-19) has been the biggest public health crisis of a generation, but it has led to organisations across the health and care sector working closer together. As a result, local and regional partnerships are stronger than ever before. It will be important to build on these relationships as London recovers from the pandemic, supported by appropriate governance and infrastructure. Services have had to work hard and fast to adapt to the demands of the pandemic, leading to innovative approaches. And, whist we mustn’t lose the benefits of innovation, the Mayor is clear that any permanent major service developments should be subject to scrutiny and public consultation.
In this context the Mayor commissioned the King’s Fund to review the development of one of the key local partnership arrangements in London, Integrated Care Systems (ICSs). Their report, Integrated Care Systems in London: challenges and opportunities ahead is published today. Its publication is timely with the recent announcement in the new health and care white paper that ICSs will become statutory. This report builds on two previous reports, the first of which led to the development of the Mayor’s six tests. The Mayor has since used these six tests to analyse and comment on several major hospital reconfiguration proposals in London.
These three reports chart a shift away from a focus on hospital bed numbers and making financial savings towards working together to tackle broad collective issues like health inequalities. The pandemic has had a devastating impact on London’s diverse communities, widening existing inequalities and creating new challenges. As such, I was pleased that the report shines a light on plans to tackle health inequalities. This is rightly a priority for all five ICSs in London, but I echo the report’s call for this to be followed through with decisive action. The Mayor is committed to using public health expertise within the work of the Greater London Authority group to help address health inequalities, and his Health Inequalities Strategy provides a great foundation for our future collaboration across the system.
The report lays bare the impact of government cuts on the NHS and local government’s ability to work together to improve the health of their local communities. Councils continue to work tirelessly to meet local needs and innovate, but the reduction in the public health grant and other funding streams hampers their ability to fully tackle some of London’s biggest health challenges, including obesity. These budget pressures have only been compounded by COVID. The pandemic has stressed the urgent need for social care reform and the Mayor continues to call on government to put social care on a sustainable footing and publish its plans for the sector.
Historic underinvestment in the workforce, compounded by Brexit, continues to affect the health and care system’s ability to respond and recover from the pandemic. Positive steps have been taken by some ICSs to bring together NHS and social care workforce planning and development at a local level. The report, however, also highlights the need for coordination at a London level, supported by the London People Board. The Mayor will continue to promote London as great place to train and work and look for other ways to help grow the workforce, for example through skills development programmes.
The report also speaks of the pace of digital innovation during the pandemic. Whilst this has been largely positive it is important to ensure that some groups are not left behind through digital exclusion or other barriers, which will only worsen inequalities. This is why ‘Digital Access for All’ is one of the recovery missions for the London Recovery Board, co-chaired by the Mayor. The report also notes that modernising and improving London’s health and care estate remains a key issue to address. It will require on-going collaboration across partners and a coordinated approach across London, using the full powers offered by the London health and care devolution act, overseen by the London Estates Board.
I appreciate that the publication of this report comes at a time when the NHS and wider health and care workforce are under immense strain from COVID-19 so I am grateful to colleagues across the system who gave their time to contribute.
The Mayor has spent the past 5 years championing and challenging the NHS on behalf of Londoners. The response to the pandemic has meant the Mayor working closer with the NHS and wider health and care partners than ever before, and he meets with both Public Health England and the NHS on a weekly basis. The recovery from COVID will make even greater demands on the system and the insight from this report will be invaluable as we explore together how we strengthen our work to meet the challenges ahead. Building on the advances made in the last year, the Mayor will continue to champion, challenge and collaborate with the NHS to ensure a fair and healthy recovery from COVID for all Londoners.
Read what Richard Murray, Chief Executive of the King's Fund has to say about the report