The union Unite has released a report looking at the state of London's NHS (PDF), a follow up to a major publication last year which helped inform the Mayor's London Health Commission.
The NHS in London is predicted to have a funding gap of £3bn-£4bn by 2019. The push for 'efficiency savings' has left the majority of London's acute providers (i.e. hospital trusts) in deficit — while the 32 GP-led clinical commissioning groups (CCGs) are predicted to have a £159m underspend by the end of March.
In contrast, the combined deficits of the hospital trusts are £253m. Kingston and Chelsea & Westminster are currently breaking even, while Guy's & St Thomas's and Imperial College are running a surplus. Epsom & St Helier, Homerton, the Royal Free, St George's and West Middlesex are only expected to turn current deficits into end-of-year surpluses/balanced budgets by using contingency reserves or one-off measures. Just Barnet, Croydon and Enfield CCGs will be in deficit at the end of the year. This imbalance between CCGs and hospital trusts leads the report's authors to suggest planning should be done over the whole local health economy, combining commissioners and providers.
On a similar planning theme, there's a call for a body to provide a strategic overview of health in London, similar to the old NHS London but with more involvement from boroughs (which are responsible for social care). Reductions in funding for social care is also flagged up, echoing one of the main factors blamed for increasing use of A&E and 'bedblocking'. The report wants more integration between NHS services and social care. Such integration is something that's being piloted in various areas of the country, but it's worth reading this Channel 4 Factcheck which highlights there isn't one magic bullet that will solve the NHS's very complicated woes.
The report also firmly opposes the closure of further A&Es until it's clear that the increased demand and pressure we're seeing on A&E services is reducing, and also until the London Ambulance Service can be expanded to meet additional pressures closures can cause. It's also against putting more NHS services out to competitive tender (i.e. privatisation), referencing Circle's failure at Hinchingbrooke hospital in Cambridgeshire and Serco's withdrawal from the market. However, it seems the public aren't that bothered about creeping privatisation: Channel 4 News cites polling that shows four in 10 people don't mind who provides healthcare, so long as it's free at the point of use.
