John Appleby introduces The King's Fund's report on health and health care in London, considering who will lead improvements and reform after Healthcare for London.

1. Improving health and health care in
London: Who will take the lead?
John Appleby
Chief Economist, The King’s Fund
December 2011

2. Old reports:
• London health care 2010:
Changing the future of services in
the capital, The King’s Fund
• Transforming health in London,
The King’s Fund
• Metropolitan Hospitals,
Provident and Other Public
Dispensaries and Charitable
Institutions for the Sick Poor,
House of Lords Select Committee
report
New report published in December 2011

3. 120 years of reviews of
London’s health services

4. Healthcare for London:
A Framework for Action
Lord Ara Darzi, 2007

5. London PCTs 2011/12 allocation

6. London trauma centres

7. Summary indicators
GP patient survey 2010
• London ranks bottom on 26 out of 31 patient
experience measures of primary care

8. Current multi-site trusts and proposed mergers

9. ‘Compared with the other nine
regions, London has the lowest
proportion of trusts that have achieved
foundation trust status (38 per cent),
and the highest number of trusts (26)
still in the pipeline. The SHAs we
spoke to in other regions agreed that,
while some individual trusts in other
parts of the country face similar
problems, the concentration and
complexity of challenges in London
are not replicated elsewhere.’
National Audit Office (2011). Achievement of
Foundation Trust Status by NHS Hospital Trusts.
Report by the comptroller and auditor general HC
(1516) (2010–12).

10. Four options for taking forward change in London:
1: Patient choice and clinical commissioners leading change in a
market
2: The NHS Commissioning Board leading change through
planning
3: Local authorities leading change through health and wellbeing
boards
4: Providers leading change through academic health sciences
partnerships

11. ‘...nothing in the Bill explains how
strategic change will be made to the
NHS. With perhaps 300 consortia,
how will the necessary changes be
made on a regional level? The
programme that I led, Healthcare for
London, built an alliance of hundreds
of clinicians and managers across the
capital to improve care. It led to
London becoming the world leader in
stroke and cardiac care... How will
similar improvements happen in
future?’
Darzi, 2011 Speech, Second reading of the Health
and Social Care Bill, House of Lords: Hansard 11
Oct 2011, Column 1493

12. Read the report
Improving health and health care in
London: Who will take the lead?
www.kingsfund.org.uk/london