London health care damaged by NHS reform

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A grim diagnosis of the state of London's health service is offered by a report, published yesterday, which says health care in the capital has been damaged by the destructive effects of the NHS market and institutional rivalries between the major teaching hospitals.

Sweeping changes are needed to improve health care and restore public confidence, the Kings Fund independent health policy think-tank, says.

The report is the second to be produced by the fund's London Commission in five years. It says little progress has been made since its first report in 1992. That laid the ground for the Government-backed Tomlinson review which recommended a radical programme to close hospitals, concentrate specialties and divert funds to the GP service and community care.

The new Kings Fund report, Transforming Health in London, says that while more than one in six acute hospital beds has been lost since 1989-90, because of the trend to day surgery and shorter in-patient stays, hospital sites have not closed. The result is higher costs and less flexibility to cope with emergencies.

The lack of nursing homes for the elderly and poor community provision for the mentally ill means that beds are blocked by patients who should not be in them. In addition, the pressures of competition and the market have required trusts to sell their services to outlying health authorities to boost income, making it harder for local people to get a hospital bed.

A key recommendation of the Tomlinson review was that specialties, which were fragmented across many sites, should be merged to concentrate skills and resources and raise standards. Five years later, the Kings Fund says this has been frustrated by the institutions to which they posed a threat.

Baron (Marmaduke) Hussey, chairman of the commission, said: "The main problem is that those with the greatest needs are getting the worst care. It is clear that the internal market fragmented care by putting dozens of health bodies in competition with each other. This report is about co-operation, working together to plan for the needs of Londoners."