BETTER HEALTH FOR LONDON - The report of the London Health Commission - LONDON HEALTH COMMISSION
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LONDON
HEALTH
COMMISSION
BETTER HEALTH
FOR LONDON
The report of the
London Health Commission
LONDON
H
HEALTH
A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
It reflects the creativity and wisdom hundreds of choices that affect our We can each choose to invest in our
of London’s extraordinary people health – how we get to and from own health and we can help each
– a report bursting with ideas and school or work, what we choose to other to choose better health.
proposals from the public and from eat, how we spend our free time. The
The ideas and proposals in this report
renowned experts. Its message is goal is to make it easier to make the
have been developed for London. Yet
simple: ours can be the healthiest healthier choice.
they could just as easily apply to other
major global city. By working together,
For many, better health comes big cities in the UK – London should
we can achieve better health for
through good care, especially from be a leader, not an exception.
all Londoners.
London’s GPs. We should be proud
A letter to Londoners Let us Londoners look forward to the
Many Londoners lead healthy lives of our NHS and our social care. But
blossoming of better health across
– eating well, exercising often, and we should not be complacent. Many
our capital city, in our homes and
enjoying fulfilling jobs and social improvements can be made to raise
our hospitals, in our schools and our
This report is about lives. Yet that is not true for all the quality and efficiency of services.
workplaces, in our parks and our
better health for London. of us. Londoners’ waistlines are At times, the challenges can seem
playgrounds. We have the shared
expanding, since we eat too much too great to meet, too difficult and
It rests on the belief that ambition: better health for London.
and exercise too little. More than a too stubborn, too deeply rooted and
Now is the time to act.
this city – its people, million Londoners still smoke, and too perennial. But I am convinced
there is significant harm from problem Londoners can rise to any challenge.
its institutions, and its
drinking. Too many children get off to
political, economic and All Londoners want to lead healthy
too poor a start in life. It’s reflected in
lives. That means that all of us need
cultural leaders – have life expectancy, which ranges widely
to work together to improve health Professor the
from one part of the city to another. Lord Darzi of Denham
an obligation to help and – schools, employers, charities and PC KBE FRS
We can do better: the healthiest voluntary groups, local and regional
support one another to Chair, the London Health Commission
choice isn’t always easy and isn’t government, transport, the NHS and,
achieve better health. always obvious. Every day, we make above all, Londoners themselves.
LONDON
H
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A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
A note on the report Ambitions for London Today, London is middle of the pack, ranked number 7 out of 14 comparable cities around the world in terms of
health, wealth and education. If we are to achieve the aspiration to be the world’s healthiest major global city, we
This report has been put together with the must improve the lives of all Londoners. We have 10 aspirations for our city, which are supported by the full list of
help of literally thousands of Londoners. The recommendations in the report (see appendix):
Commission has held engagement events,
roadshows and hearing sessions, in order to London aspires to be the
Our aspirations for London Our ambitions for London
listen to the views of Londoners about what world’s healthiest major
they wanted for the health of their city. 1 Give all London’s children a healthy, Ensure that all of London’s children are school
global city. happy start to life. ready at age five.
You will hear and see this engagement Halve the number of children who are obese by the
throughout this report. There is also a huge Today, London is middle of the pack, time they leave primary school and reverse the trend
amount of detailed work sitting behind this ranked number 7 out of 14 comparable cities in those who are overweight.
report and each recommendation, in terms of around the world. London can do better, and Get London fitter, with better food, more exercise Boost the number of active Londoners to 80% by
2
further statistics, data and analysis. match its cultural, economic and political and healthier living. supporting them to walk, jog, run or cycle to
school or work.
preeminence by being the world’s healthiest
This evidence, and a longer, more detailed major global city. Make work a healthy place to be in London. Gain 1.5 million working days a year by improving
3
version of the report, notes on contributors and employee health and wellbeing in London.
a full list of Commission members can all be Help Londoners to kick unhealthy habits. Have the lowest smoking rate of any city over
4
found on the Commission’s website: five million inhabitants.
www.londonhealthcommission.org.uk 5 Care for the most mentally ill in London so they Reduce the gap in life expectancy between adults with
live longer, healthier lives. severe and enduring mental illness and the rest of the
population by 10%.
6 Enable Londoners to do more to look Increase the proportion of people who feel supported
after themselves. to manage their long-term condition to top
quartile nationally.
7 Ensure that every Londoner is able to see a GP General practice in London to be open 8am to 8pm
when they need to and at a time that suits them. and delivered in modern purpose-built/designed
facilities.
Ranked number
7 14
8 Create the best health and care services of any Have the lowest death rates in the world for the top
world city, throughout London and on every day. three killers: cancer, heart diseases and respiratory
out of illness. Close the gap in death rates between those
comparable admitted to hospital on weekdays and those admitted
at the weekends.
cities around Fully engage and involve Londoners in the future Year on year improvements in inpatient experience for
9
the world health of their city. trusts outside the top quintile nationally.
10 Put London at the centre of the global revolution Create 50,000 new jobs in the digital health sector.
in digital health.
LONDON
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A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
A picture of London's health
A third of GP premises
need rebuilding. Using NHS facilities
London spends £22.5bn on health better could unlock £1.5bn.
and social care services.
And employs more than 400,000
people in the health sector.
London loses 6.63m working
days a year due to stress, anxiety or
depression. More physical activity could
Over 8,000 fast food outlets in save 4,100 Londoners' lives per year.
London, many close to schools.
If mortality rates at the weekend were
the same as during the week, 500
lives could be saved.
The life expectancy of a man who
has psychosis is 65 years.
This is the same as the typical life
expectancy of a man in 1954.
7% of deaths in London are
attributable to air pollution.
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Engagement
Engagement events held by the Commission
Enfield
Commission Hearing Sessions
Trust events Barnet
Waltham
Roadshows Harrow Haringey Forest
Redbridge
Havering
Islington
Brent Hackney Newham
Camden Barking &
Dagenham
Westminster City of Tower
Ealing Kensington London Hamlets
Hillingdon
& Chelsea
Hammersmith Southwark
Hounslow Bexley
& Fulham Greenwich
Lambeth
Richmond Wandsworth Lewisham
Merton
Kingston Bromley
Croydon
Sutton
The Commission has travelled all over London to collect views
about the health of the city, involving more than 9,000 people.
The GLA's Talk London online community of 4,000 people
participated; more than 50 roadshow and NHS-based events
were held, at least one in every borough; 250 written evidence
submissions received; and 9 oral hearing sessions conducted.
Every contribution has been analysed and considered.
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Better health for all
Smoke free London London’s obesity emergency
Each year, more and more Londoners are More than 3.8 million Londoners are obese or
choosing to quit smoking, improving and overweight. Our city has too many people who
lengthening their lives. We need to help more eat too much and exercise too little. Obesity
Londoners to do the same. Smoking is still the raises the risk of serious physical health
leading cause of avoidable deaths: every year, conditions such as diabetes, heart disease,
more than 8,000 Londoners die prematurely stroke and cancer. It affects our mental health,
from tobacco-related diseases. our sense of self-esteem and happiness.
Hundreds of children take up smoking every We need to help ourselves to make better
week – two classrooms full a day. With choices. London councils should use licensing
advertising outlawed, they do so inspired by to require all chain restaurants and food outlets
the adults that they see. Just as smokers’ to include nutritional labelling on all menus.
Listening to Londoners lungs are polluted, the lungs of our city – our
Regrettably, a sugar tax for London alone is
Londoners want to lead healthy lives – health parks and green spaces – are polluted by
impractical. The London Health Commission
comes first for all of us, our family, friends, smoking. Our parks and green spaces account
gives its full support for a national sugar tax.
neighbours and colleagues. The Mayor, for nearly 40% of the capital, the equivalent
London’s authorities and institutions, and all of 20,000 football pitches; imagine that space
Londoners can benefit and can contribute. completely smoke free.
The NHS must be more open to those The Mayor should use his byelaw powers to
make Trafalgar Square and Parliament Square Deaths attributable to smoking in London boroughs
contributions. It must get better at listening
to people, responding to them, and providing smoke free. Local authorities should use their
more convenient and relevant ways for them to byelaw powers to make local parks smoke Rate per 100,000 people, 2010-2012
share their views. More voice must be given to free. The Mayor should direct the Board of the 186 405
London’s diverse communities, some of which Royal Parks – whom he appoints – to make
can be hard to reach but all of whom want to all of the parks and open spaces that they 8,400 deaths
be listened to, want to be more involved, and manage smoke free. The Mayor should also per year
target illegal tobacco. Equivalent to
want to make a greater contribution. 23 deaths per day
8,400
DEATHS PER YEAR
23 DEATHS
PER DAY
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A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Better health for all
Tackling problem drinking Total number of alcohol related hospital admissions in London by gender/year
London’s pubs and bars are part and parcel of More Londoners should be encouraged to Men Men WomenWomen
what makes it a great world city. But in parts walk, with joint action from employers, the
of London, drinking alcohol is a problem. Not Mayor, local councils, and Transport for
everyone drinks sensibly and alcohol related London. The Mayor should dedicate 20% of
hospital admissions – and rates of liver disease his TfL advertising space to a campaign and
20,000 20,000 20,000 20,000
– are rising. alter signage in stations to encourage people to
walk up stairs and escalators.
In the UK and around the world, others 16,000 16,000 16,000 16,000
are taking action. The Liverpool Health Employers can do their part too, recognising
Commission has supported the introduction of that a healthy workforce is a productive one. 12,000 12,000 12,000 12,000
the minimum alcohol price using local authority TfL should establish a scheme, paid for by
byelaws. Newcastle has also introduced employers, to incentivise walking the last mile 8,000 8,000 8,000 8,000
minimum unit pricing through a voluntary to work and the first mile home.
agreement in part of the city. London should 4,000 4,000 4,000 4,000
London’s professional football clubs have
collaborate with Liverpool, Newcastle and other
a huge influence over the city’s people and
cities on this initiative. 0 0 0 0
could also help, with a ‘fan challenge’ to 2008/09 2010/11
2008/09 2012/13
2010/11 2008/09
2012/13 2010/11
2008/09 2012/13
2010/11 2012/13
Particular boroughs face more severe alcohol improve physical activity levels by offering club
problems than others and, since boroughs are incentives and by using physical activity league
responsible for licensing of venues that sell tables to promote competition.
alcohol, an application could be made to the Currently 13% commute to work by walking or cycling with the highest rates in Inner London
London could also do more to harness the
Government to approve variations in licensing Private transport Other Walk or cycle
benefits of its unusually large amount of green Commute by walking or cycling
to enforce minimum prices in pilot areas. Public transport
space not only by curbing unhealthy activities
32
7% 28%
28%
in parks, such as smoking, but also by using 32
Private transport²
them as a natural rallying point for healthy activity.
Getting London fitter
Just as we have chosen to eat more, we 11
Other
have also chosen to exercise less. Just as we
need to discourage consumption of too much
food and cheap alcohol, we should positively 1313 Walk
encourage more Londoners to take or cycle
more exercise.
54
54
Public transport¹
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COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Better health for all
Cleaner air Deaths attributed to air pollution in London
Poor air quality in London contributes to
people dying nine months sooner in the 50% Proportion of deaths attributable to particulate air pollution
city than they should – 50% worse than the
worse than
6.1% 8.9%
national average. Some 7% of all adult deaths
are attributable to air pollution. the national
London could improve its air quality by average
accelerating plans to convert taxis to zero
emission capable vehicles. London’s 25,000
taxis cause 10% of nitrogen dioxide pollution
and 25% of PM10 levels in central London. 5.4% 7.2%
The 15-year age limit should be reduced
to 5 or 10 years, supporting the Mayor’s
announcement that all newly built taxis would
need to be zero emission capable by 2018.
The Mayor should also be more ambitious
in his proposed Ultra Low Emission Zone
Proportion of deaths attributabl
by aiming for near zero emission by 2025,
6
expanding the size of the zone, and offering
stronger financial incentives and disincentives. England London
5.4% 7.2%
England London
LONDON
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A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Better health for London’s children
Better parenting Childhood obesity just 55% of London’s children are physically
active. Education also lowers the chances
Healthy child development is fundamental London has the highest rate of childhood of teenage pregnancy, with all its attendant
for good health and a happy life. Level of obesity of any peer global city, and the highest health and life opportunity challenges, and
development at age five is a crucial indicator proportion of obese children in all the regions influences rates of sexually transmitted
of how a child’s life will unfold. Yet today just of England. In London almost one in four infections.
53% of London’s five-year-olds reach a good children in Reception and more than one in
level of development at this age. three children in Year 6 are overweight Each day in London, the anti-smoking
or obese. And obesity is a particular challenge message fails to get through to the 67 children
The problem in London is that there is no who start smoking. Smoking in the young is
for some of London’s poorest and its minority
London-wide systematic focus on particularly damaging. Schools are the obvious
communities, with the highest prevalence
pre-school and early years parental place to educate about and prevent smoking.
in poor areas and amongst Black
intervention. Significant results could be
African children. We need to help our children There also needs to be greater transparency
achieved through a London-wide programme
make healthy food choices. All London about the health of London’s schools. A
of parenting support for the most
councils should follow the lead of Waltham Healthy Schools London dashboard could
vulnerable groups.
Forest, Barking and Dagenham, and Tower be created for schools and parents to allow
Staff providing early parenting support could Hamlets by refusing permission for fast food comparison between schools on how they
also be developed, to link families with various outlets to open within 400 metres of schools. support the health and wellbeing of their pupils
charities, voluntary groups and statutory The Mayor should include this guidance in his alongside educational attainment.
programmes of support. Children’s centres London Plan. Healthier alternatives should
and other providers could receive a kite also be promoted.
mark for quality, and a network of academic In parts of London a quarter of children leaving primary school are obese
units could be developed as a resource for Percentage of reception children Percentage of Year 6 children
evaluation and evidence. The charitable sector RECEPTION YEAR 6
Healthier schools classified as obese classified as obese
should be tapped into to understand how the
funding gap for supporting parenting proposals If London is to do more to look after its 2012-2013 2012-2013
6% 27% 6% 27%
could be addressed. children, more needs to be done in the places
where children spend most of their waking
hours – schools. More children say they get
53% of London’s their information about health from either their
parents or their teachers than from television
five-year-olds reach a good or from the internet. So schools are the ideal
place to get kids off to a healthy start in life.
level of development at
Good education improves health; poor health
this age with wide variation harms education. Similarly, physical activity
within London linked to and exercise improves motivation, reduces
deprivation and place unhappiness, and improves learning – today,
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Better health for London’s children
Better children’s mental Better children’s physical
health services health services
But it would be misleading and wrong to London’s hospitals need to ensure that there
Half of all mental illness in adults starts before The death of any child or young person
suggest that general practice alone is are enough paediatrics staff, with the right
a child reaches the age of 14, and three- is a tragedy and, fortunately, is rare.
responsible. Health and care services for skills and sufficient experience and seniority
quarters of lifetime mental health disorders Nonetheless, there are wide variations in
children in London are hard to access, poorly for good clinical decision making, available
have their first onset before 18 years of age. mortality rates across boroughs, both for
coordinated between primary, secondary and every day.
One in ten children and young people aged infants and older children. There is a threefold
tertiary care, and there are inadequate links
5–16 have a diagnosable mental health difference between the best and worst There is a lack of planning and coordination of
between them.
disorder, equating to three in every class, performing boroughs. services across London. There is a need for
or more than 100,000 across the capital. Hospital care for children and young people more integrated systems, spanning primary
Whilst most causes of deaths are similar to
Between 1 in 12 and 1 in 15 deliberately in London faces particular problems. Although and community care to highly specialised
those across England, there are some aspects
self-harm – admissions to hospital have there are multiple causes, case reviews have hospital services, and linking with education
that are unique to London. The city has a
increased by 68% in 10 years. highlighted that regardless of where the child and voluntary sector, to ensure better
significantly higher proportion of children and
dies – in primary, secondary or tertiary care – outcomes for London's children and
Making a difference is possible. Mental health young people who die of acute infections or
there are often avoidable factors in their families.
assessment in schools may have a role to acute medical or surgical problems. There are
secondary care.
play in preventing mental health problems and also more children and young people dying in
identifying children at risk of developing such emergency departments and hospital wards.
disorders early on. Currently, assessments in
The National Children’s Bureau has
school focus solely on the physical health of
highlighted the need for better paediatric
the child.
expertise in GP practices and opening hours
Increasing health literacy in schools and that meet the needs of working parents and
teaching coping strategies has been shown their children. This could help reduce child
to reduce the risk of mental illness among deaths and relieve the increasing burden on
adolescents. Early intervention programmes A&E services.
work well, even with the most severe
mental illness.LONDON
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A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Better care
Making care more personal
London has a history of successful change. More specific detail on these groups, their London should also do more to help More must also be done to join up care. Today,
For example, over the past seven years, organisation and their needs and costs, is people look after themselves, providing the three-quarters of people who have more than
the capital has undertaken radical reform of included on the Commission’s website. information they need to do this. Partly, this one long-term condition say their conditions
specialist stroke services, changes that are is about better provision of information and are treated individually rather than as a whole.
now hailed as ‘one of the greatest stories of Empowering people and education, but it is also about encouraging an Nearly half of people under 65 say that they
modern medicine’. professionals interest in health. have to repeat their health history every time
Empowering people to have a more active they see a health or social care professional.
Better care starts with the individual, with The Commission believes there is an
making care personal. Understanding the and dynamic role in their own care is central opportunity to explore enshrining self-care Community services play a vital role in
care needs of individual people, and how to providing better and more personal and education about self-care and self- providing better joined-up care. There is a
these patterns of need are spread across the care. People who use services and the management in a more formal way, to give need for service providers and commissioners
population, is the first step in improving care. professionals who provide care must work those who need it more authority and power to work together, focusing on delivering better
together as partners. to make the choices that will result in better outcomes and placing people at the centre,
Care needs to be more personal, which
We need to listen to our people about what care for them. with services designed and delivered around
means tailoring care to individual needs.
matters to them, we must include patient their needs.
Our approach is to achieve this by grouping
the population by needs that are similar. A voices in addressing these areas of concern
universal health system can’t offer a bespoke and give patients an active role in re-designing
service – London can’t have eight million care the system. We must all work together to
models. But it can tailor care so that it is better better educate people about their conditions,
suited to individual lives. and empower them to work in partnership with
their providers.
Our maxim is: start with Londoners, not
London’s NHS. Start with people and how In today’s world of a ballooning burden of long-
best to meet their needs, their wants, and term conditions, people expect to be partners ‘Mostly’ healthy
(rest of the
One or more physical
or mental long-term
Severe and
enduring Learning
Severe
physical
Advanced
dementia,
Socially
excluded
their expectations – not those of the system. in their care, making the decisions that best Age population) conditions Cancer mental illness disability disability Alzheimer’s etc. groups
Practically, it means more joint teams in the suit their needs. Dialogue with people who ‘Mostly’ healthy Children with intensive continuing care needs N/A Homeless
Children and young people with
community, more joined-up working and more use services needs to be reframed, and made 0-12 children one or more long-term condition individuals
1 or cancer 9 and/or families
integration between health and social care. more personal, changing from ‘what is the (including
children, young
matter?’ to ‘what matters to you?’ ‘Mostly’ healthy
young people
Young people with intensive continuing care needs
people, adults
We propose that care be designed around 13-17
and older
people), often
15 groups, with joint teams working across The best work on improving the health and 2 5 10
with alcohol
‘Mostly’ healthy Adults with one or more Adults and Adults and Adults and Adults and
specialties and current organisational care system happens when people who use 18-64 adults long-term condition
Adults and
older older people older people older people older people
and drug
dependencies
boundaries to provide care. This would mean services are embedded throughout the design 3 6
people with severe and
enduring mental
with learning
disablities
with physical
disabilites
with advanced
dementia and
with cancer
that a single team would be accountable for of those improvements. Experience has ‘Mostly’ healthy older Older people with one or illness Alzheimer’s
people more long-term condition
the mental, physical and social care for people demonstrated that so-called ‘lay partners’ can
65+
in different groups. positively contribute to this.
4 7 8 11 12 13 14 15LONDON
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Better care
Better GP care We asked Londoners what they expected from general practice, and this what they said...
For the vast majority of people in London, their In the future, GPs should be expected to
local GP is the NHS. The Commission firmly deliver consistently high standards of care,
believes that GPs are one of the greatest and should be empowered to respond Howmoregeneral
strength of London’s health system. Yet it also practice care
flexibly to the different needs of different
observes the urgent case for change. groups in the population. Londoners will be different,
should be
according
able to select practices that best serve their to
London’s GPs are under unprecedented
needs, based on clear information,people’s
choice andneeds
pressure, facing a rising workload, falling
ease of switching from one practice to another.
numbers, and a poor working environment,
Technology used to access care should be Proactive care that Coordinated care that Access options
whilst spend is tumbling as a percentage of
more prevalent, and more up to date. supports healthy lives supports people with that suit people’s
total expenditure on health.
If patients in London were able to access a complex needs different needs
Perhaps not surprisingly, GP services in
network of practices, it would make care much
London are not as good as they should be. Patients should be involved in Care should be customised to People should have rapid and
more convenient and accessible, support
Nearly two-thirds of London practices perform co-designing services – particu- individuals, including the provision convenient access to GPs at a
the development of scale by practices, and larly people with long-term condi- of personalised care plans that treat time and location that suits them –
worse than the England average in overall tions or disabilities, and their carers, people holistically. Care plans should for example, near to a person’s
enable networks to be either local or non-
patient satisfaction and accessibility. who are often experts in their own adapt as people’s needs change. workplace for the working-age
geographical, for example offering practices in needs and the care that works best. population.
train stations and near people’s homes. Patients who have complex
The Commission believes that general GPs should be able to signpost Flexible offering of
needs and need coordinated
practice needs more investment and more patients to local activities and care should receive multi-disci- appointments, including time of
Where GP practices persistently fail to groups that can improve their plinary reviews to enable all of their day, same-day appointments,
reform, and is proposing an investment
improve, new providers – such as other more wellbeing, life satisfaction, general conditions to be treated as advance bookings and being able to
programme totalling £1 billion of public capital mental health, and which can reduce effectively as possible. request a named GP, should make it
successful local practices – should be allowed feelings of isolation – particularly for easier to get an appointment at a
over the next five years. NHS England should
to set up new GP services. older people and carers. Care should be coordinated convenient time with a GP who
also rebalance expenditure from specialised between general practice and knows patients' medical histories
and who is familiar with their
services to primary and community services, other healthcare providers, as
GPs should act as gatekeepers conditions.
well as social services, to ensure
specifically general practice. for healthy lives, referring patients all patients receive seamless care.
to public health services, such as People should be able to access a
smoking cessation, where wider range of services within a
There should be improved
appropriate. network of GPs, with extended
Proportion of spend on general practice by coordination with secondary care opening hours and appointments
particularly following discharge from
commissioners in London 2004-2012 Routine mental health screening available seven days of the week.
hospital or treatment.
should be offered by all practices, to
10.8 enable early detection of possible People with long-term conditions or
11.0 10.4
symptoms of depression and other
Information sharing between complex needs should be able to
10.5 9.9
mental illnesses. providers will mean that patients request longer appointments with
10.0 are treated by health professionals
GPs they know.
Percentage of total spend
9.5
8.8 8.6
8.9
Prevention should be part of with up to date knowledge of their
8.6
9.0 health status and needs.
8.5
8.4 everyday business – this is Flexible ways of booking and
8.0
particularly important for people who holding appointments (e.g. online,
7.5
do not access services very often or Skype, email) would make it easier
7.0
who may not be registered. for people to get appointments –
6.5 particularly younger people who are
6.0 more open to using technology.
5.5
2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011-
2005 2006 2007 2008 2009 2010 2011 2012LONDON
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Better care
Better specialist care Fourth, we must provide more, better care Better care for homeless
in local communities to tackle the gaps in
In order to provide better, more personal care, Mental illness affects a greater proportion Londoners
physical healthcare and poor diagnosis rates
we must also improve our specialist services. of people in London than anywhere else in among the mentally ill. At any one time, hundreds of people sleep
Many recent reforms in the type and quality England. The city itself often exacerbates this, rough in the capital. The homeless population
of specialist care in London have been very and yet people with mental illness are less To tackle these issues, the mental health trusts
has a life expectancy of only 43–47 years,
successful: for example, the Healthcare for likely to receive treatment than anyone else in will lead an all-London, all-agency pledge to
compared with 80–84 for the general
London programme. the health and social care system. identify and treat psychosis in half of cases
population, and is more afflicted by
within two weeks and all cases within eight
The Commission believes that the Despite the number of Londoners affected mental ill health.
weeks of the first signs and symptoms.
momentum created by life-saving initiatives by mental illness, the care they experience is It is common for people who are homeless
for specialist care like Healthcare for often poor, as are the outcomes. Mental health trusts should proactively offer to suffer from a number of complex and
London should be given new impetus. access to smoking cessation, blood pressure interrelated health problems, with almost a
London should feel deeply ashamed that
Other parts of the specialist care system monitoring and treatment, and effective weight quarter having physical health, mental health
people with severe and enduring mental
that could benefit from the same approach management programmes to all people under and substance use needs. This commonly
illness die more than a decade earlier than
– for example, cardiovascular, cancer and their care. Commissioners should ensure includes drug or alcohol dependence, mental
those without. Our mental health care must
elective orthopaedic services – should be that all people with severe mental illness ill health and respiratory conditions. There are
improve urgently. More can be done to provide
actively directed towards reform, and those receive an annual health check, including significant public health risks of infectious,
ongoing, effective and reliable support for
programmes which are already under way cancer screening, with an action plan to treat multi-drug resistant tuberculosis – indeed,
people with long-term mental illness.
should be accelerated. identified health issues. 1 in 10 people with tuberculosis have a history
First, we must provide better, more of homelessness.
innovative support for people suffering from
Homeless and rough sleepers are a transitory
Better care for people with mental illness. Young people are at particular
risk of loss to follow-up, partly due to problems population, meaning that homelessness is
mental illness necessarily a London-wide issue.
with the transition from child to adult mental
Mental ill health is all around us. It is health services. A London-wide approach could be achieved
experienced by our family, our friends, our by appointing a single ‘lead’ integrated care
Second, we must ensure good access to
colleagues – and ourselves. On average, commissioner for London’s homeless. This
psychological therapies and early
mental ill health affects thirteen people on the could either be NHS England (London), or one
intervention services.
busy bus with us in the morning, more than a of London’s CCGs acting on behalf of all of the
hundred people on the tube train on their way Third, we must improve specialist services. others and working in close collaboration with
into work, three of the children in our child’s Substantial change is needed for specialist local authorities for social care and
school class, and 10 of our fellow mums services to reduce the reliance on inpatient housing needs.
and dads. care. More joined-up working will be vital
to address this. The police are an essential Homelessness instinctively jars with
Over 1m partner, often being the first group to come into Londoners. The Commission heard a strong
message that London needs to act together as
Londoners per contact with people in crisis, and responsible
year experience for taking them to a place of safety. a city to improve the health, care and lives of
mental illness some of our most vulnerable people.LONDON
H
HEALTH
A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Maximising science, discovery and innovation to enhance economic growth
Digital health
London has a proud past and a promising delivered, but also how patients of the 21st The amount of data available opens up new possibilities
future of boundless possibilities in science, century can access care. to shift care from a ‘diagnose and treat’ to a ‘predict and
1928 1973
discovery and innovation. Our city is home to prevent’ model. Data can help promote population health
Fleming World’s first
That is why a new Institute for Digital Health discovers
many of the world’s leading medical, academic and wellbeing, as well as delivering new personalised bone marrow
and Accelerator should be launched, that penicillin transplant at
and scientific institutions. treatments tailored for specific individuals. – St Mary’s Westminster
partners with – and is embedded across – all 1953
Hospital
1902 Wilkins & Franklin
Some of the most important innovations our Academic Health Science Centres and The NHS as a whole has aBaylisswealth of data,
& Starling part of DNA
in modern medicine hail from here, from Networks (AHSC/AHSN). discover hormones
unsurpassed by any other health system in discovery
– St Mary’s – King’s
antiseptics to penicillin and from hormones both its depth and breadth. Yet this has not
This city should define the new frontier of
to DNA. translated into sufficient improvements to
research in digital health. Our city should be
London has the potential to lead the way the place that develops global standards for care, not least 1850
because the UK’s analytical 1900 1950 2000
in the new health economy and in global conducting digital health clinical trials and the capabilities are struggling to keep up.
trends in digital health. The interface between evidence base for digital health interventions. The proposed Institute for Digital Health
health and technology has the potential to could help to build capabilities and support
The Institute for Digital Health should also
revolutionise the way that people manage their advanced analytics on ‘Big Data’ to provide
directly
1928 support digital health innovators 1877 1928
health and care. 1973 outstanding care and better research into 1950 1973
through
Flemingan ‘accelerator programme’. The
World’s first
Lister pioneers Fleming Hill and Doll World’s first
With its strength in the creative and tech discovers
Institute and its AHSN partners should bone marrow new treatments for aseptic
our citizens,
surgical today discovers establish link bone marrow
penicillin techniques penicillin
industries, London is uniquely placed to develop
– St Mary’san app strategy that addresses
transplant at and tomorrow. – King’s
between cancer
– St Mary’s and smoking
transplant at
1953 Westminster 1953 Westminster
foster entrepreneurship and become the1902 areas of importance for Londoners, Hospitalsuch as 1902 – LSHTM Hospital
Wilkins & Franklin 2001 Current day Wilkins & Franklin
world’s leading digital health hub.YetBayliss London
& Starling mental health, self-management
part of DNA of long-term Bayliss & Starling part of DNA
discover hormones discovery
GlaxoSmithKline Researchers develop
discover hormones discovery
remains a difficult market in which to– launchSt Mary’s
conditions, or how to conveniently access the launches Advair, a– St Mary’s material to create
– King’s – King’s
digital health products, particularly for small nearest and best social and healthcare services. 1928 best-selling asthma biocompatible human
1973
1928 drug – GSK artificial
1973 organs and
and medium sized business. It is too hard to Fleming World’s first
access capital, and1850
clinical input, and to get1900 1950 2000 1850 1900 1950 2000
Fleming
discovers blood vessels
World’s
bone first – UCL
marrow
discovers
penicillin bone marrow
transplant at
penicillin
– St Mary’s transplant at
Westminster
products purchased and adopted by the NHS. Big data – St Mary’s 1953
Westminster
Hospital
1902 1953
Wilkins & Franklin
As a result, too many entrepreneurs decide to 1902
Bayliss & Starling 2010Wilkinspart
& Franklin
of DNA 2015 Hospital 2001 Current day
2001 Current day develop
launch their products overseas rather than The amount of data the world is collecting Bayliss hormones
discover & Starling Johnsonpart &discovery
Johnson
of DNA Francis Crick GlaxoSmithKline
GlaxoSmithKline
Researchers
Researchers develop
discover–hormones
St Mary’s discovery
–Imperial
King’s launches Advair, a material to create
is growing by 50% each year. Substantial purchases Institute to open
at home. – St Mary’s – King’s launches Advair,
best-selling a
asthma material to create
biocompatible human
spin-out RespiVert, supported by £650 best-selling
drug – GSK asthma biocompatible
artificial organshuman
and
1877 benefits across the NHS could be 1877
Obtaining the evidence base required achieved with
1950
better data analytics 1850
and 1900 which
1950
pioneered million in total
2000 1950 drug – GSK artificial organs– and
blood vessels UCL
to demonstrate the impact
Lister pioneers
of surgical
aseptic new digital
Hill and Doll 1850 1900 Lister
treatments
aseptic
1950
pioneers
for
surgical
investment –2000 six Hill and Doll blood vessels – UCL
use of information, to underpin service
establish link severe inflammatory member consortium establish link
techniques techniques
technologies can be very difficult. Unlike between cancer lung disease – between cancer
– King’s transformation. The Institute for Digital
and smoking – King’s
Imperial College and smoking
2010
2010
2015
2015
traditional medicines, there are no Health would–be well-placed to
LSHTM London – LSHTM
Johnson & Johnson Francis Crick
Johnson
purchases & Imperial
Johnson Francis
Institute Crick
to open
standardised clinical trials for new digital independently assess and inform health purchases
spin-out Imperial
RespiVert, Institute to by
supported open£650
1877 spin-out RespiVert, supported by £650
products. Yet these new technologies have providers of these opportunities. 1877
1950 which
which
pioneered
pioneered
million
million
in total
in total
Lister pioneers 1950
Hill and Doll treatments for investment – six
the power to change the way in which care is Lister pioneers
aseptic surgical Hill and Doll
establish link treatments
severe for
inflammatory investment
member – six
consortium
aseptic surgical
techniques establish link severe inflammatory member consortium
between cancer lung disease –
techniques
– King’s between cancer
and smoking lung disease
Imperial –
College
– King’s and–smoking
LSHTM Imperial College
London
– LSHTM LondonLONDON
H
HEALTH
A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Maximising science, discovery and innovation to enhance economic growth
Dementia research More clinical trials Adopting innovation
Today, 72,000 Londoners suffer from Clinical trials are necessary to develop new Innovation advances our ability to treat and Measurement can improve the pace and
dementia. Ten years from now, nearly a third drugs and to translate scientific advances into manage disease, to alleviate suffering and to scale of adoption, but measurement of
more will. By 2025, one million people in patient therapies and treatments. However, improve the experience of care. It is vital that process without a link to clinical outcomes
the UK and over 60 million globally will have the UK has historically lagged behind other innovations are adopted so that we close the provides little incentive for care providers.
dementia. The annual financial impact on the European countries in the number of trials that gap between what we know and what we do. Further academic rigour and experience
UK is already £26 billion, with a further £8 it conducts. could be tapped to better understand how
Adopting proven innovation should be part
billion attributed to the value of carer’s work. measurement might be used to improve
It takes too long to navigate the necessary of the day job for clinicians and managers in
uptake of innovations in the NHS.
It is surprising, therefore, that the UK currently approvals, it is too difficult to recruit patients, the NHS. This means measures of innovation
lacks an institute of global significance. A and quality and timely delivery is too should be included within, rather than outside, Commissioners should seek out more support
Dementia Research Institute could bring challenging. To improve the process, UCL the core NHS performance framework. and advice on the latest innovations from
together the breadth of interdisciplinary Partners in central and north-east London Academic Health Science Networks. The
expertise, to work in partnership and make has established a single process – a ‘unified whole system – led by patients – needs a
significant progress to meet the challenges. gateway’ – for all commercial trials, saving way to hold itself to account in the adoption of
significant time and cost. The rest of London innovation for the delivery of world class care.
A Dementia Research Institute in London
should take a similar approach.
could potentially connect a network of partners
to enable faster progress in prevention More needs to be done to support wider
and earlier diagnosis, research, translation engagement in trials. GP practices and smaller 5 out of 6
of discovery science to care delivery, trusts have little incentive or support to engage Academic Health
development of public policy, and education, in research. This could be addressed if each London's Science Centres
health and Number of
training and capacity to support better Clinical Research Network invested in a are in London,
social care employees in
dementia care and outcomes. strategic research office to offer more practical Oxford and
spend London's health
support for practices and trusts. Cambridge
£22.5bn sector 400k
London's
life science
sector
spend £2bnLONDON
H
HEALTH
A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Making it happen
This report sets a bold agenda for improving The Commission itself has sought to use Over the year, more than 9,000 people Better information
health and care in London. Its implementation best practice and exemplary engagement have been involved in more than 50 events.
will rely on the passion and commitment of to develop its report and make its Every contribution – whether by email, on Londoners understand the need for
Londoners to make change happen. There are recommendations. Significant time and paper, or verbally – has been analysed, appropriate information to be shared with an
important changes that need to be made to the resources have been invested to try to ensure shaping the Commission’s conclusions and individual’s care team in a timely and
way that the health and care system operates this report is based on quality, in-depth, recommendations. secure way.
to enable that change to happen. Many of substantial engagement and evidence The Commission believes people should be
London has an opportunity to lead the way
these are necessarily technical. from Londoners. empowered through access to their own
for England. Our city should embed the
health information, which is also shared
Better engagement The Commission travelled to every borough engagement of people in designing, delivering,
and widely across the NHS. Nine oral hearing using and evaluating services at every level among those who need it to provide care.
One of the dilemmas facing the NHS in sessions took place and more than 250 written – across the city, in communities and among People should be able to access data held
London today is that, although there is strong evidence submissions were received. The individual citizens. within their health records, and to provide
recognition that it belongs to everyone, people GLA’s Talk London online community, with consent and filter sharing of their information.
do not feel involved in it. There are too few Any new initiatives should be careful not to They should, as a result, be able to be true
4,000 members, participated. Representative
opportunities for citizens to shape the strategy duplicate the good work that already exists, partners in care delivery, contributing to clinical
samples of London’s population were polled.
and priorities of the NHS. The NHS needs to particularly in the third sector, which has some conversations and taking greater responsibility
be more open and collaborative in seeking excellent examples of effective engagement. for their own care.
answers to the problems it faces, through a London and the NHS should tap into the
new NHS Citizen initiative which is being With consent, relevant information should be
different conversation with the people who own
established by NHS England, to develop its shared flexibly and efficiently with all those
it and want to be active in its future.
own brand and drive its own engagement. involved in care, making use of existing
systems. Safeguards should be in place to
We asked Londoners how they would rate their most recent experience of the following
protect Londoners’ privacy and confidentiality;
healthcare services... Community and social
information should be secure and shared only
A GP (NHS or An A&E An urgent care centre services, such as district nurses,
Community and social
out of hours) department or walk-in clinic physiotherapy and so on
A GP (NHS or
5 hours)
An A&E An urgent care centre
4 1 clinic
services, such as district nurses, as needed.
out of 6 1
department
6
or walk-in 4 3 2 and so on
physiotherapy
8 10
5 6 1 41 74 32
8 10
37 11 6 37
48 As greater sharing of data and patient
11 41 7 48
37 11 information aids better care, so should
11 10 37
41
GP 10 A&E it enable the easier introduction of more
GP A&E personalised care. For this Commission, data
37
35 36 42 about how patients use services, about their
37
35 36 42
condition and their care, has been essential to
Mental health Telephone or online Pharmacist to
services health advice ask for advice our work on understanding population groups
Mental health Telephone or online Pharmacist to
7 2
services 2 1advice
health
6 11advice
ask2for
8
Very good
in London. The Commission wants health and
11 7 2 6 21 30 2 11 Very good
Good
care commissioners to have access to the
8
11 41 16 30 42 Good good nor poor
Neither
41 16 Neither
Poor good nor poor
same information for their local populations.
42
11
Poor poor
Very
11
Very poor
Don’t know
48 Don’t
Preferknow
not to say
29 45 48 Prefer not to say
29 45LONDON
H
HEALTH
A letter to Londoners A picture of London's health Better health for all Better care Making it happen
COMMISSION Ambitions for London Engagement Better health for London’s children Science, discovery and innovation Recommendations
Making it happen
Funding Capitated budgets for
Today, the total CCG budget is allocated to Importantly, the proposed shift to more integrated care
each individual CCG according to a nationally integrated care requires long-term investment The NHS budget is distributed to care To meet these challenges, other countries
agreed formula that is intended to reflect the in preventative health by providers. For providers through multiple different payment have trialled making a single provider – or
care needs of each local population. The providers to undertake such investments, they mechanisms. Some providers are paid fixed a consortium of providers working together
allocation varies significantly from one part need to be assured of multi-year contracts to sums of money for their services; others are – accountable for all the care needs of a
of London to another. The most well-funded care for a particular population. paid on a tariff for different services; many particular group of people. The whole budget
CCGs receive 54% more money than those have specific targets and incentives built for these groups in a particular place is then
Significant effort will be required if the
with the least funding. into their payments; and all are paid through handed over, tied to an agreed set of
NHS in London is to deliver against these
However, reforming such complex funding recommendations. It will require investment complex contracting processes. quality outcomes.
allocations takes time, and requires multiple of time, energy and money in change. Those This approach has its advantages – money This approach has significant advantages. It
levels of decision making. In the meantime, changes need to be led by commissioners, follows patient choices, providers are paid gives providers a strong incentive to invest
some areas of London are being overpaid and who will need a dedicated team to take for results, and it keeps waiting lists down. in more personal, more preventative care. It
others underpaid. them forward. Nonetheless, it has many drawbacks too enables providers to holistically judge and
Some parts of the capital, such as CCGs in Furthermore, it will require significant – duplication because similar services are deliver the best care for an individual. It
North West London, have already developed investment in programmes to improve health funded by different organisations, gaps in causes providers to ensure care takes place in
joint financial strategies to reflect the and care. It is proposed to create a London provision, siloed working arrangements, and lower cost settings, and to ensure it is
interconnectedness of their health economies Transformation Fund that will be jointly providers focused on treating people when carefully coordinated.
and to promote financial stability. There is a managed by NHS England’s London region they are sick rather than helping to keep
strong case for CCGs in other parts of London and CCGs. Investments in improvements them well.
to follow suit. in care would be agreed with local health
economies in London.
Good planning requires clarity and stability in
budgets, so that commissioners and providers
of care can invest in improving services.
Significant gains could be made by extending
the horizons for strategic planning in London.You can also read
