Independent commission to be set up to investigate health services

An independent commission is to be set up to investigate the provision and resourcing of health and care services in the capital, it was announced today.

Led by Lord Ara Darzi, the London Health Commission will be established by the Mayor of London to help support the work of the London Health Board (LHB), which was set up earlier this year by London Councils, the Mayor and key health partners to provide strategic leadership across the capital. The new commission will inform the response of the LHB to the stark challenges facing the health service as set out in “A Call to Action” published by NHS England earlier this year. This will feed into the strategic plans of NHS England and Clinical Commissioning Groups, which jointly hold the ring on planning London's health services over the next three to five years.

The LHB wants to ensure there is adequate funding and support to serve the needs of London's population and has a key role to play in ensuring the unique characteristics of health and care in the capital are clearly understood during a period of significant change for the sector and amidst continued financial pressures. The London Health Commission will gather comprehensive data and undertake new analysis, as the LHB makes the case to government for appropriate resources in the capital.

London faces particular challenges. For example, the city's population is rising faster and is more ethnically diverse than any other region in the England. Health inequalities persist and parts of the capital have some of the highest child poverty rates in the country. Infection rates for TB, HIV and conditions such as sickle cell are also higher in London, as are rates for people with mental ill-health. Outcomes for cancer can also vary widely, depending on where you live or are treated, which is exacerbated by still too low early detection rates. Primary care provision remains variable across the city and some of the most deprived people still have poor access to comprehensive healthcare.

The London Health Commission will focus on three key areas. Firstly, it will establish whether the specific needs of London’s diverse population are adequately understood by government and reflected in allocation formulae. Secondly, it will assess the sustainability of healthcare services in the capital, looking at the systems that prevent Londoners getting ill in the first place, identifying current and future challenges, based on the changing needs of the population, its use of services, from primary to acute care, and social to community care. Thirdly, London is home to some of the country's leading health research institutions and the commission will consider how they and their partners can best be supported.

Boris Johnson, Mayor of London and Chair of the London Health Board, said: 'It goes without saying that adequate funding and resources are needed to ensure all Londoners, wherever they live in the capital, have access to world class healthcare. With fundamental changes underway in a huge and complex sector it is critical that we gather hard evidence about services in London, to build a compelling case as we fight for resources and work to ensure they are used effectively.

'Over the next period, the London Health Commission will be seeking input from a wide range of stakeholders and partners to build a comprehensive picture about the state of health and social care in one of the most diverse cities in the world. It is vitally important that we arm ourselves with compelling and credible evidence to present to central government.'

Lord Darzi said: 'I am delighted to have been approached by the Mayor to lead this independent commission. I have always believed that as a leading world city London should have exemplary health services to match. I will consider over the next few weeks how best to establish this vital work these arrangements will be announced in due course.'

The London Health Commission will feature an executive group to deliver the work programme and an advisory board, which will include members from the LHB and other health stakeholders such as the GLA, London Boroughs, MPs, patients groups, voluntary sector organisations, Public Health England, NHS England and regulatory bodies. The commission will seek input and evidence from a wide range of stakeholders report its findings to the Mayor in autumn 2014.

Dr Yvonne Doyle, Regional Director of Public Health England in London, said: 'London is a modern city without modern health outcomes for all of its residents. The commission is a welcome development, which will be an opportunity to get to the root of major public health problems across our city, like TB and HIV, and see real health benefits for Londoners.'

Dr Anne Rainsberry, Regional Director of NHS England in London, said: 'The Mayor’s announcement of a new London Health Commission is good news. In October, NHS England in London will publish an analysis, or a case for change, which will describe the unprecedented challenges the NHS faces over the next ten years. We have fast paced technological advancements in surgery and medicine, an ageing population living with serious and often multiple long term conditions and we have to deliver consistently high standards of care, including fulfilling non-clinical needs, for every patient, in every NHS setting, at a time when we all expect higher standards of service integration and customer care.

'The NHS in London requires radical reform if is to meet these pressing challenges. The Mayor’s Commission will provide a fresh perspective to help all of us in health and care shape services for the future.'

Dame Ruth Carnall, specialist health advisor to the Mayor of London, said: 'Lord Darzi has unique experience of healthcare in the capital, together with a global reputation in biomedical research and health policy. He will bring all that experience to bear in the vital task of ensuring a high quality, sustainable health service for London.'

ENDS

Current facts and figures

• The capital’s population is growing at a faster rate than any other region in England .Between the 2001 and 2011 censuses, it grew by 14% (1,002,000) compared to the national average of 8%. By 2020 London’s population will exceed 9 million residents.
• The number of Londoners aged 65 or over is set to grow fastest of all age groups at 19%. Alongside this, though, London has the second highest birth rate of all regions.
• There is evidence that many Londoners have undiagnosed and untreated chronic conditions. Stroke, Alzheimer's and chronic obstructive pulmonary disease (COPD) are of particular concern. As many as two thirds of residents in one borough are expected to have COPD remain undiagnosed.
• As is the case nationally, cardiovascular disease, cancers and respiratory diseases are London’s leading causes of death. Although better than some other parts of the country, London’s cancer outcomes remain poor by international standards, largely due to later detection rates.
• London has the highest prevalence of childhood obesity in England, in both reception (11.6%) and year 6 children (21.8%), and there has been little change in recent years. Adult obesity is growing with almost a quarter of London’s adults now obese.
• With over 1.5m Londoners suffering from mental ill-health, London has a higher rate than the national average – 18% compared to 16%. Mental ill-health costs London £5.5 billion in working days, and £2.5billion in health and social care costs .
• The rate of acute sexually transmitted diseases is over 50% higher than any other region and the 10 local authorities with the highest rates of acute STIs are all in London . More than fifty per cent of people with HIV live in London.
• 40% of the nation’s tuberculosis (TB) cases are in London residents and the new case rate in some boroughs is over six times higher than the national average .
• London has a greater prevalence of diseases that are rare in others parts of the country (e.g. malaria, sickle cell), that require specialist centres of care.
• Less than half of patients report being able to get a GP appointment before the next working day. This contrasts sharply with the service provided by A&E where patients can be seen, treated and discharged within 4 hours 24/7. It is estimated that as much as 30% of the A&E caseload is typical of a primary care mix.
• Across London there is a shortage of home and community based care available for patients, carers and their GPs, particularly in times of urgency or crisis. This results in hospitals admitting patients who do not need acute care and retaining patients whose needs could be met in a more appropriate setting. Emergency admissions for acute conditions that do not usually require hospital admissions have more than doubled in past 10 years .
• While acute urgent care is working towards a 7 day model, this is not yet the case for other parts of the system which adds pressure on beds, with patients more likely to get admitted out of hours. In contrast, areas with well-developed integrated, primary, community and social care services have lower rates of hospital bed use.