BBC London’s Karl Mercer has set out some big numbers about the National Health Service in London:
- Each year 60 million GP consultations take place, roughly 165,000 a day.
- Nearly £18bn is spent on the NHS in the capital.
- There are roughly 8,000 GPs in approximately 1,400 practices.
- There are 60,000 nurses within London’s NHS, local authorities and voluntary sector.
- Over a million operations took place in London during the past year.
These figures provide a sense of how vast the health care system is across the capital and how great the demand for it is. Londoners won’t need telling how strained much of that system is, perhaps especially at GP level, where simply trying to get an appointment to see your doctor can be enough to induce depression or a stroke.
This is not only about money. It’s also about structures, cultures and priorities. Mercer recalls the NHS London Framework For Action, published ten years ago. This emphasised prevention of illness as well as the treatment of it and the need to localise and co-ordinate different parts of the health and social care services. That plan was scheduled to have been put into full effect this year, but it was junked by the coalition government in 2010.
Since then, some of the 2007 framework’s broad principles continue to be embraced but have increasingly come to look like cover for implementing cuts. The current sustainability and transformation plans (STPs), which propose creating five London regional “footprints”, contain ideas that London health professionals support but a recent report from the King’s Fund think tank criticised NHS England for keeping them shrouded in secrecy and concluded that they had become more and more shaped by financial considerations.
There is, then, an urgent need for a thought-through approach to NHS provision in London that reconciles budgetary considerations with organisational efficiency to produce the best possible outcomes for a large and very complex population. A general election campaign should be when arguments about the best approach are illuminated and compared. This one has been a big disappointment.
The Conservatives, whose credibility on the NHS is weak at best, are promising a real terms increase in NHS spending nationally, but even if that sounds better than nothing it will not allay suspicions about the STPs or keep up with increasing demand. Theresa May flannels about Brexit enabling the UK to reduce net immigration. That won’t do much for Londoners’s NHS, given that about 13% of its medics and other staff are from other EU states.
Labour, whose Old Time Religion manifesto is attractive in parts, say they would put more extra money into the NHS nationally than the Tories and halt the STPs in favour of more community input. But there are serious doubts about their ability to raise the taxes they would need and while community input is very important, it can often amount to a clamour for no change of any kind, especially if reorganisation means local services being changed or moved elsewhere. The party’s blanket objections to any form of private sector involvement in health provision are more ideological than practical. There is little recognition that the NHS will need to adapt to the changing needs being placed upon it and that in Stepney these will be very different from in Southwold or South Shields.
The Liberal Democrats bites a big bullet on taxation in general – they recognise that pretty much all of us will have to cough up a bit more if the public services we say want are to be paid for, including health. They aren’t going to form the next government, though. The Greens say much the same as Labour on the NHS. UKIP blame foreigners, as usual. A gloomy prognosis all round.