London’s unique health needs require the local solutions – the case for devolving the capital’s health funding

Every aspect of our health care system in London is at capacity. Hospitals, GPs, ambulances, mental health and social care services are all struggling to cope. Our frontline NHS services in London have been pushed to a cliff edge.

Nurses and doctors are being asked to deal with the results of poorly thought-out, short-term policy making across government with a single goal – to save money without any regard of the cost to patient care.

London’s hardworking paramedics, nurses and doctors deserve better from the Government. London’s patients deserve better too. This is why my recent report Critical Condition, examines the dire state London’s NHS finds itself in and the steps we must take to halt the decline.

London’s health needs are unique compared with those of the rest of the UK; we have fewer smokers, less risk of heart disease and lower cancer rates than the rest of the country. On the other hand we have a much younger and diverse population, higher rates of teenage pregnancy, childhood obesity, HIV, serious mental illness, and suicide.

London’s different needs require different solutions. A tailored approach, based on a model akin to that proposed for Manchester but resilient to London’s needs, is necessary. A pan-London strategy of this kind would not only see health and social care services working together to deliver the care appropriate for our unique demographic, but would also help us to deliver strategic investment and innovation.

Devolution is not about creating a postcode lottery – it is about solving one. We need a health system which can respond to our local needs and which is continually prepared to face anything from an Ebola outbreak to a terrorist attack.

We must end fictional divisions between physical and mental health, between hospital and community care, between public health and acute care. Only through coordinated cooperation between each of these areas can they become more than the sum of their parts.

A London solution, including the establishment of a health commissioner, could increase politically accountability in a similar way to that seen with the Metropolitan Police Service. A London Health Board would also deliver a more strategic approach to public health and health and social care provision.

In the meantime, urgent action is needed to reduce the ever-growing strain on London’s NHS. Boris Johnson, and whoever is Mayor after him, has a key role to play in that.

The Mayor must call on NHS England to halt any further closures to A&E and Maternity wards and to halt the reduction in hospital beds until a full comprehensive review of London’s health services has been completed.

They must prioritise reducing the shortfall of 8,000 nurses and 400 paramedics by drawing up a plan for key worker housing. We need to re-establish a system where we can provide for the key workers who keep our city healthy and save our lives. This is yet another area where London’s unique challenges are impacting on its Health offer.

We also need to recognise the challenges we face and lobby the Government to start the process of bring primary care up to standard across London – a process estimated by Lord Darzi’s Better Health for London report to cost up to £1bn. Whilst at the same time ensuring we have an equitable distribution of primary care across London and that deprived areas are not under-serviced.

A new approach is absolutely essential if we are to rescue London’s ailing health system. Integrated physical, mental and social care will provide better care and be more sustainable. We need a re-alignment of social care, prevention and primary care in order to reduce long term illness and health inequalities. Our health and care into old age, and the survival of the NHS, depend on it.

Dr Onkar Sahota is a Member of the Greater London Assembly for Ealing and Hillingdon, as well as a practicing GP in West London. He is Chairman of the Assembly Health Committee.