London's healthcare services-again

摘要

Could there possibly be anything more to say about London's health services? First, we had the report of the first King's Fund Commission on London, London Health Care 2010, then the Tomlinson report, and then the government's white paper, Making London Better, which established the London Initiative Group and the London Initiative Zone for primary care development All the reports stressed the need to improve primary care, especially me quality of general practice, the importance of rationalising and reconfiguring acute hospital services, and the need to reshape medical education and research to shift the focus of services towards community based rehabilitation and continuing care. Huge efforts have been made in the past five years, but there is considerable scepticism that much has really changed. Plans to reconfigure acute hospital services have been stalled by local and political opposition and delays in agreeing funding through the private finance initiative. Londoners are still poorly served by general practice. Numbers of beds have fallen to national averages, but older people in deprived areas have a worse chance of getting hospital care than in other areas and receive poor continuing care in the community because of a lack of coordination between health and social services. Mental health services in particular are under severe and unacceptable strain; it is salutary to remember that in 1900, 35% of the total public health and social services budget in London was spent on caring for people with mental disorder whereas it now represents only about 10% of total expenditure on health and social services.