For more than 100 years, reviews of health care in London have highlighted the poor health of the population in some areas, variations in the quality of primary care, and inappropriate configuration of hospital services. The most recent review, led by Ara Darzi, set out some proposals for change, many of which were implemented by NHS London. However, the coalition government has halted these reforms and offered different criteria for change.
Many of the historical problems remain and the crucial question, highlighted by The King’s Fund’s latest report is: who will take the lead in improving health and health care in London? London is at risk of operating within a strategic vacuum following the abolition of London’s strategic health authorities by April 2013. This report suggests there needs to be much greater clarity of roles and responsibilities within the reformed structure to avoid ambiguity and confusion.