London Health Commission recommendations on healthcare delivery could be "revolutionary", says expert

The independent London Health Commission, chaired by leading cancer surgeon and former healthcare minister Lord Darzi, was set up last year to report on ways to make London the world's healthiest major city within the next decade. Healthcare expert Barry Francis of Pinsent Masons, the law firm behind Out-Law.com, said that the Commission's final report included "challenging and potentially revolutionary" recommendations which, if implemented, could lead to real changes in the design and delivery of care.

"Whilst many headlines will concentrate on the commission's suggestion that smoking be banned in parks, the really challenging and potentially revolutionary aspects of the report are around the design and delivery of care around the patient and patient groups, the increase in concentration and reorganisation of primary care, the fusion with social care and the realisation of surplus assets to make all this possible," he said.

"These challenging objectives and means of delivery will need the freeing-up of thinking, new organisations and new models for delivery and finance. By balancing enthusiasm with realism, much can be achieved," he said.

The report made 64 recommendations based around improving the health of London's children and Londoners in general, providing better care, and maximising science, discovery and innovation. A new post of 'health commissioner for London', appointed by and reporting directly to the mayor, should also be created to coordinate the work of London councils, clinical commissioning groups and the NHS, according to the report.

One of the central recommendations of the report was a move away from care planned around generalists that work in GP practices and specialists working in hospitals, towards a "more personal" approach "planned around groups of people with broadly similar needs". Practically, this would involve more joint teams working in communities and a more holistic approach to healthcare which integrates physical, mental and social care services.

The Commission recommended that £1bn of investment be made available over a five year period in order to modernise GP surgeries, one third of which it found were 'very poor' or 'unacceptable' during its research. Darsi said that this amounted to just 26% of anticipated capital spending on healthcare in London over the next five years, and would leave £2.8bn to be invested in hospitals and other care facilities. This investment should be matched with "new, more stretching" and "more tightly enforced" care standards, and the creation of new practice "networks" to provide a wider range of services and more appointments at more convenient times.

The report also recommended more efficient use of NHS-owned land, with that not used for patient care either sold off or used to provide affordable housing for their staff and other workers. It proposed ending the public subsidy for unused hospital assets by raising capital charges from 2016/17 to match the market cost of capital, and allowing London NHS trusts to keep a share of the proceeds of any property sales in order to encourage redevelopment and disposal.

The Commission also proposed the creation of a new Institute for Digital Health which, working with Academic Health Science Networks (AHSNs), would be able to support innovative healthcare developments. It said that it had secured in-principle commitments worth a combined $500bn from five of the world's largest healthcare companies to fund this new facility. London healthcare providers should also collaborate on a "simple and unified gateway" for clinical trials, and establish a 'strategic clinical research office' to increase late-phase research.

The report also made a number of practical recommendations to tackle the health risks posed by tobacco, alcohol, obesity, lack of exercise and pollution which it said amounted to "the biggest public health drive in the world". These included banning smoking in all of London's parks and public spaces, the introduction of 'traffic light' labelling on restaurant menus and restrictions on fast food outlets near schools.

"A truly great global city is a healthy city," said Lord Darzi. "London aspires to be the world's healthiest major global city. That means a city that helps its people to make healthier choices, it means a city that focuses on improving the health of the most vulnerable and it means providing consistently excellent care for people when they need it."

"The ideas and proposals in this report have been developed for London. Yet they could just as easily apply to other big cities in the UK – London should be a leader, not an exception. I passionately believe that Britain's local and city governments can become the defining locus for better health," he said.