Health leaders call for radical and urgent change to the NHS in London

A changing population and old ways of providing care are creating a £4bn funding gap

A growing and ageing population, higher than ever patient expectations and zero financial growth means the NHS needs radical reform if it is to avoid a £4 billion funding gap by 2020, Dr Anne Rainsberry, regional director for NHS England has warned.

Launching an analysis of the state of the capital’s health and care services, NHS England (London region) said the NHS must change the way services work or risk harming patient care – including increasing waiting times for treatments and limited or unsafe services at weekends.

Sixty five years ago, the NHS was set up to beat killer diseases, but as we have become more scientifically advanced and affluent, age and lifestyle related conditions now account for the biggest demand on the NHS.  Around 80 per cent of premature deaths in London are attributable to lifestyle factors, such as alcohol, smoking, poor diet and a lack of exercise.

Health inequalities and the capital’s growing demand for healthcare from a ballooning and ageing population means the existing model of NHS health and care is unsustainable.

The health issues affecting London include:

  • Health inequalities: Life expectancy in London has risen by 5.2 years since 1990 – a year longer than the national average – but stark variations exist between boroughs.  Every two stops of the Jubilee line represents a year of life lost between residents of the most and least deprived areas.
  • A rising birth rate: more than 130,000 women give birth in London every year, and the birth rate is increasing by 3 per cent a year.
  • Ageing population: the number of Londoners aged 65 and over is set to increase by 19 per cent by 2020.  The NHS needs to adapt to meet this increasing demand and care for all of us, for longer.
  • Childhood obesity:  1 in 5 children in London are at risk of obesity – higher than the national average – and mostly prevalent in London’s poorest communities.  These children are increasing their likelihood of developing other serious conditions such as diabetes and cardiovascular conditions.
  • Patient experience and satisfaction rates are not good enough:  Despite rates of public trust in the NHS remaining relatively high compared to other national institutions, London has worrying trends of low satisfaction levels.  For instance, when it comes to cancer services, nine London hospitals are in the bottom 10 for patient experience nationally (Macmillan).
  • Cancer care:  London has poor rates of early diagnosis for diseases like cancer.  Around one in three cancer diagnoses are made in A&E.  It is estimated that London could save 1,000 more lives per year if early diagnosis rates equalled the best in Europe.
  • Sexually transmitted diseases: The rate of acute sexually transmitted diseases is higher in London than in any other region.  The 10 boroughs in England with the highest rates of sexually transmitted infections are all in London.  More than 50% of people with HIV nationally live in London and 40% of the nation’s TB cases are in London.
  • Patient expectations are rapidly changing:  Patients want to see their GP more quickly – before and after work and at the weekend.  And many patients with long term conditions want to see their GP more frequently.  The NHS has to change so that routine services are more available.

Anne Rainsberry, Regional Director of NHS England – London said:

“We need to look more at how we can help people to stay well, rather than focussing on treating them once they are ill.  Particularly for the increasing number of people living with long term conditions we need a step change in the way care is planned with patients and the way we use technology to support people.

“We have to do more with our existing budgets to keep the NHS free at the point of care.   Based on our expectations of patient demands and that we expect a period of flat financial growth we are likely to have an affordability gap of £4 billion in London by 2020.

“Investing more in hospitals is not the answer; we need to focus more on prevention and improve our primary and community care services to coordinate services closer to where patients live.”

Dr Andy Mitchell, Medical Director for NHS England in London, said:

“We need to rethink where and how services are provided around the needs of patients – not the needs of healthcare professionals or around individual institutions.

“The NHS has spent the last 65 years treating disease and ill health.  Now we are treating more and more conditions that stem from what we are doing to ourselves. Lifestyle choices like smoking, excess drinking, unhealthy diets and a lack of exercise are all adding greater pressure on the NHS. The NHS is helping more people survive common diseases, and helping many others to manage often more than one long term or complex condition.”

“London’s hospitals are at breaking point and the demand for healthcare will outstrip the funding available in just seven years unless we fundamentally change the way services are delivered.

“It is time to start listening to leading doctors and nurses about how we can adapt and change if the NHS is to survive. This will mean some difficult decisions need to be made.”

The stark warning was made at a meeting of London’s most senior NHS health and care leaders and commissioners.  The analysis published today highlights that rising patient demand and rising costs, including medicines and technology, will make the NHS rapidly unsustainable, creating huge financial pressures.

NHS England is using this analysis to trigger a discussion with Londoners about the way health and care services need to change over the next decade to meet the evolving needs of the capital.  These discussions, to be led by London’s Clinical Commissioning Groups working with Health and Wellbeing Boards, will be used to inform detailed plans that will shape local health services over the next five years.

If Londoners would like to get involved in the debate, they should contact their local Clinical Commissioning Group (CCG) about public engagement events in their area. They can also join the Twitter conversation using #NHScalltoaction or they can complete a short survey on