Access to healthcare, the quality of treatment, and health education are suffering under the pressure of rapid population growth and government cuts – yet the mayor of London, Boris Johnson, whose job it is to reduce health inequalities, has done nothing about it.
Londoners are living longer. Yet for an increasing number of individuals, more of their years are spent suffering with ill health or disability. Across the city men have lost six years of healthy life expectancy and women women fare worse still, losing 8.6 years between 2001 and 2011.
Whilst the gap in life expectancy between the richest and poorest parts of the city may be narrowing, the gap in healthy life expectancy has expanded rapidly. In 2015 a woman from Tower Hamlets can expect to suffer for 18 years more in poor health than a woman from wealthy Richmond, almost double the gap from ten years ago. This inequality isn’t only unjust, but places considerable strain on social and health services.
Strategic leadership lacking
London has a unique health environment. 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 a younger population – but this has meant higher rates of childhood obesity, HIV and serious mental illness. To ensure the NHS and social services match up to the challenges in the capital we require a level of strategic leadership which has been sorely lacking under Boris Johnson.
Consider the silence over Christmas 2014 as London’s hospitals were revealed to have experienced the worst A&E delays in the history of the NHS – only three of London’s 19 trusts hit their waiting time targets. Some hospitals, as a result of the government’s decision to close other nearby A&E units, saw just over half their patients within four hours. The target is 95 per cent.
When the overstretched ambulance response times grew to historic levels we heard nothing from our mayor – not to even express shock or disappointment, yet alone show the leadership Londoners are crying out for.
Major health inequalities
The mayor’s direct role in London is to reduce health inequalities, yet here too we see failure and disinterest from Boris Johnson. Over the eight years of Johnson’s mayoralty, only three years have been covered by any kind of plan to tackle health inequalities.
In response to the growing pressure the mayor faced to take action on health and inequalities, the former health minister Lord Darzi was appointed to lead a London Health Commission. He was tasked with collating the challenges and proposing solutions to the capital’s key health challenges. Lord Darzi published his finding in October 2014 to almost universal approval and enthusiasm.
One year on and most of the Commission’s 64 recommendations remain a dream or ambition. Without a serious mayor to advocate for the recommendations they will not happen. The loss of strategic health leadership in London and the Mayor’s unwillingness to step into the breach has been lamented by healthcare leaders and politicians alike.
Perhaps, therefore the most significant recommendation by Lord Darzi was the creation of a health commissioner for London, supported by an agency comprising of Public Health England’s London office and the GLA’s health team to provide strategic solutions to strategic problems.
With an agency of significant resourcing and influence, many of the underlying causes of health inequality could be addressed, and many of the structural barriers between local government, NHS commissioners and providers could be negotiated and overcome.
London being left behind
As London’s health landscape stagnates, Greater Manchester is forging ahead with a £6bn programme of health and social care devolution. We need this type of thinking in London right now – because we face even bigger health challenges in the future. London’s high cost of living has led to a recruitment crunch in the London Ambulance Service, whilst the city is short of 8,000 nurses.
Many of our GPs are reaching retirement with nowhere near enough recruited to fill their place. Population growth is rocketing at the same time as investment is stagnating and many of the community-based services Londoners rely on are being cut.
After eight years of Boris Johnson, and despite growing health inequalities, Londoners still await a mayor with both the energy and passion to bring about the kind of radical strategic change the city needs to become healthier and fairer.