A FRAMEWORK - nhshistory

1 A FRAMEWORK FOR ACTIONA FRAMEWORK FOR ACTIONJULY 2007 FRAMEWORK For Action 2/7/07 13:25 Page 1 ContentsForeword by Professor Sir Ara Darzi2 Summary4 Introduction14 The case for change16 Future demands on healthcare29 Improved care from cradle to grave41 Maternity and newborn care43 Staying healthy49 Mental health55 Acute care60 Planned care67 Long-term conditions72 End-of-life care78 Future models of healthcare provision87 Turning the vision into reality: improving healthcare for London113 Appendix 1: Clinical working group membership 130 Appendix 2: Supporting material134 Second editionA FRAMEWORKFOR ACTION1 FRAMEWORK For 25/7/07 17:22 Page 1A FRAMEWORKFOR ACTIONFOREWORDBy Professor Sir Ara Darzi1 London is one of the greatest cities in the for over two thousand years, it has arich historical and architectural heritage.

2 It is acity renowned for its vibrant artistic and creativeoutput, as well as for being a hub of innovationand invention. It is a financial powerhouse,rivalled only by New greatness is the achievement of London swonderfully diverse inhabitants. London is acultural melting pot, its inhabitants drawn fromevery corner of the globe. These people, and this city, deserve the verybest. The inhabitants of a world-class city shouldnot have to settle for anything less than world-class , we know at present that whilst there isexcellence in healthcare in London, that excellenceis not uniform. There are stark inequalities in healthoutcomes and the quality and safety of patient careis not as good as it could, and should, be. The need for improvement was recognised byNHS London, the Strategic Health Authority forthe capital, and I was asked by them in 2006 tocarry out a review of London s healthcare.

3 As asurgeon who has spent all my working life inLondon, I was delighted to accept that request. This FRAMEWORK for Actionsets out my findingsfrom the review. It details how I believe London shealthcare needs to change over the next tenyears. I think these evidence-based proposalsoffer a compelling vision for the at the moment these proposals are onlywords implementing them will be a majorchallenge. I am well aware that this reviewfollows in a long line of reports into thehealthcare of sceptics maywonder why this Frameworkshould fare anybetter than previous reports, reports which haveonly ever been partly hope and believe that this FRAMEWORK forActionwill not just sit on a bookshelf gatheringdust. Let me give you six reasons why I think thisreview will bear fruit. First, clinicians acrossLondon have been involved in the review s workand there is a considerable clinical consensusbehind this report s proposals.

4 Second, we havebased the Frameworkon what Londoners have2 FRAMEWORK For 2/7/07 11:16 Page 2A FRAMEWORKFOR ACTION3told us they want, so I believe we will have thepublic s support for the proposed changes. Third,because my proposals are to improve the qualityand safety of the care patients receive, I hopepoliticians of all parties will support them. Fourth,NHS London exists as a pan-London body todrive forward strategic changes in healthcare andis ideally placed to take forward the review srecommendations. Fifth, we have looked beyondthe vision and identified the key enablers thatwill turn this vision into a reality. One key leverwill be the commissioning regime. Another willbe continuing our engagement with the GreaterLondon Authority, the Mayor, London boroughsand other partners to deliver change on theground.

5 Sixth and finally, as a practising surgeonI m going to be around in London to championthese proposals and help make them I let readers venture into the main sectionof the report I want to acknowledge thatwithout the contribution of several individualsand organisations this Frameworkwould nothave been published. The sheer number ofcontributors means that I have not beenexhaustive and I apologise to any whom I haveneglected to thank here. Imperial College, St Mary s Hospital and theRoyal Marsden have been gracious in allowingme the time to conduct this review. ThePresidents of the Royal Colleges gave of theirexpertise to help me develop my ideas. TheKing s Fund kindly allowed us to use their roomsfor the myriad of meetings and events that thereview inevitably members of the six clinical working groupscontributed a considerable amount of their timeand expertise especially Cathy Warwick, MaggieBarker, Tom Coffey, Martyn Wake and Sir CyrilChantler who, along with me, each chaired agroup.

6 The chief executives of London s mentalhealth trusts kindly helped me develop robustproposals in their particular area. NHS London provided a lot of support thatenabled me to carry out my review, especially SueDutch, Gary Dakin and Catherine Martin whomanaged the many consultation events and RuthCarnall, Bill Gillespie, Steve Gladwin and HannahRich for their full support of this review. Workingfor NHS London, Nicholaus Henke, Penny Dash,Ben Richardson, Chris Llewellyn, Eoin Leydon and their colleagues identified national andinternational good practice, as well as carryingout much of the analytical work underpinningmy proposals. Michael Soljak, John Hamm andTrudi Kemp helped a great deal on ourprojections for future needs and our analyticalmodelling. Sue Atkinson carried out a preliminaryhealth inequalities assessment on the I would like to thank the review team hereat Imperial College, including Peter Howitt, OmerAziz, Erik Mayer, James Kinross, Rachel Davies,Deborah Crewe, Penny Humphries, Helen Cullenand Beth Jantz for their dedication and effort.

7 Professor Sir Ara Darzi, KBE, FMedSci, FREng (Hon)1 Professor Sir Ara Darzi, KBE, FMedSci, FREng (Hon) ThePaul Hamlyn Chair of surgery, Professor of Surgery andHead of Division Surgery, Oncology, ReproductiveBiology and Anaesthesia, Honorary ConsultantSurgeon St Mary's Hospital and The Royal MarsdenHospitals NHS Foundation See for instance Report of the Inquiry Into London sHealth Service, Medical Education and Research(Tomlinson Report) 1992, London Healthcare s Fund Commission on the Future of London sAcute Services, June 1992, Transforming Health inLondon, King s Fund, 1997 and (Turnberg Report) 1998 FRAMEWORK For 4/7/07 10:49 Page 3A FRAMEWORKFOR is a world-class city and Londonersdeserve a world-class healthcare system. But,though there are many areas of real excellencein London, of which we should be proud, world-class care is not currently what every Londonercan expect.

8 There are stark inequalities in healthoutcomes across London, and the quality andsafety of patient care is not always as good as itcould, and should, be. report makes recommendations for is based on a thorough, practitioner-led process,and rooted in evidence gathered from a widerange of people and organisations from the worldof healthcare and from the NHS s partners in localgovernment and beyond, from thorough reviews ofthe literature and data, and from the use of a rangeof analytical modelling techniques. It also reflects amajor exercise to hear what Londoners say theywant from their healthcare system. It sets out acompelling ten-year vision for healthcare in London. The case for in London needs to change. Thereare many excellent reports considering howhealthcare must change in the future, both ingeneral and in particular specialties.

9 This reportfocuses on the specific challenges for London. We need to improve Londoners s health services need to be able totackle some health challenges that are specific toLondon notably high rates of HIV, substancemisuse, mental health problems, and high ratesof childhood obesity. They also need to be ableto meet the needs of our wonderfully diverseand highly mobile population. The NHS must beaccessible to all. The NHS is not meeting Londoners is much public supportfor the work done by the NHS. But not allexpectations are being met. Twenty-seven percent of Londoners are dissatisfied with therunning of the NHS compared with eighteenper cent nationally. Londoners are also lesssatisfied than people nationally with their GPservices. Though the NHS has improvedconsiderably over the last twenty years, it hasnot kept pace with rising expectations.

10 TheNHS in London will have to work harder tomeet the expectations of Londoners andrespond to their concerns. London is one city, but there are biginequalities in health and of care is a founding principle of theNHS, but healthcare in London is notequitable, either in terms of mental andphysical health outcomes, or in terms of thefunding and quality of services data mask significant example, Westminster and Canning Townare separated by just eight stops on theJubilee Line, and by a seven-year disparity inlife expectancy. And there is significantvariation in GP distribution, with overall fewerGPs per head in some of the areas wherehealth need is greatest. The hospital is not always the set out in the White Paper, Our health, ourcare, our say, most people are best cared forby community services.