London has some significant health and care challenges and inequalities. The healthcare system continues to be poor at preventing ill-health and in diagnosing illness early, and too much care is provided in hospitals instead of in the community.

London has the highest average income but it is also the most polarised in the country, with people in the top 10% of households earning around five and a half times more than those in the bottom 10%. On the whole, people in the more deprived boroughs in London have poorer health. In many London boroughs poverty and affluence and the associated health inequalities exist side by side. In Tower Hamlets women have life expectancy of 54.1 years compared to 72.1 years for women in wealthier Richmond-upon-Thames, a gap of 18 years.

There is growing pressure on health and social care systems. The number of people with multiple long-term conditions is set to grow to 2.9 million by 2018 and the number of older people likely to require care is predicted to rise by over 60 per cent by 2030.

More than 1.5 million Londoners live with mental illness which ranges from anxiety, depression, and bipolar disorder to schizophrenia. Mental ill health is more common in London than in other parts of the country with 18% of people living in the capital having a common mental health problem, compared to 16% nationally. London’s leading causes of premature death are from predominantly treatable conditions such as cardiovascular disease, cancers and respiratory disease. Around 80% of these deaths are attributable to lifestyle factors such as excess alcohol, smoking, lack of physical activity and poor diet. Obesity is a bigger problem in outer London, although inner London has higher rates of early death from heart disease and cancer.

Across London there is a serious shortage of home and community-based care available for patients and carers. Around a quarter of patients who do not need specialist care are admitted to hospital as a result of this, and up to 60% of patients are kept in hospital beyond five days when their needs could be met in more appropriate and cheaper community settings. State-funded social care spending decreased by £1.5 billion between 2006 and 2013 (2012/13 prices). This included a 39% reduction in the use of services for older people, 48% reduction in the use of services for adults with mental health needs and 33% reduction in the use of services by people with physical disabilities.

Hospital admissions in non-urgent cases could be avoided with better proactive management of patients’ condition in their own home or within a community facility. There is an emerging social enterprise movement of approximately 1000 healthcare co-ops working within the NHS with a combined turnover of £600m. Social enterprises, housing associations and the third sector have developed a range of services to support the marginalised and disadvantaged communities in London in part funded by personalised budgets. We need much more of this approach in London, as it puts more choice in the hands of patients and successfully prevent conditions getting so bad that admission to hospital is required.

Here’s how we could promote more patient power through the use of social enterprise in London’s healthcare system:

  • make third sector, social enterprises, co-operatives and mutals preferred providers in commissioning healthcare, and take action when there is a bias against using these providers;
  • give patients and staff more control over hospitals by changing foundation trusts into co-operatives;
  • increase the use of personalised budgets and allow budget holders to pool funding to increase their purchasing power to help shape the market and develop more choice;
  • charge private-sector NHS providers 5% of gross profit they make from these services to help develop patient-led healthcare social enterprises with a particular focus on the most socially excluded communities.

We need a co-operative healthcare agenda for London to give patients a bigger say over the care they receive, reduce health inequalities, and move towards services that prevent health conditions becoming health crises.

First published by the Co-operative Party

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  1. Mutualising health care is the fastest way to privatisation, when the funds are deliberately dried up, underfunding, then they can be picked off like ripe cherries.

  2. George Nieman says:

    Nothing must be allowed to take any part of the NHS away

  3. All hospitals and health and social care responsibility, where possible, should be transferred to local ownership in whatever form can be held locally and democratically accountable. The current system is an insult to democracy and is a further insult to the majority and generations of British citizens who paid for the system to be built, for staff to be trained, for systems and infrastructure and for the purchase of some services that have made some people very wealthy.

    Putting GPs in control of purchasing is ridiculous and why anyone would do that I don’t understand. GPs should do what they were trained to do assess and treat patients as the first line of healthcare. Although I would advocate GP representation on a provisioning board with others.

    Assessing provision of healthcare for a region or local authority area should be done by a provisioning board not a commissioning board. No one on that board should have any interests in any healthcare providing company. The board should be made up from elected councillors from county and borough councils, local professionals including consultant surgeons, health managers, nursing staff and social workers, teaching profession, police service, fire service and patients. I would far rather put my trust in those people we rely on across our public services to do right by me than I would politicians alone or any other individual group. All areas of public services have a link to health and healthy communities. Provision needs to be organised with clear and effective collaboration between all of these services with the expectation that cross overs happen and are sometimes necessary.

    Of course a provisioning board would have support from accounting and auditing specialists – preferably locally sourced or in house.

    This reminds me somewhat of the original NHS with much more devolution and local accountability.

    Mutuals are not a good option in, my opinion, because they put ownership in the hands of those treating you and that, for me at least, is a conflict of interest that should not be put on healthcare professionals.

    A robust complaints process with an independent and supportive inspection system should have regular and detailed oversight.

    I would like to see far more integration of health and social care management and arrangement processes although with clear designation and career pathways for frontline staff.

    I would also like to see a system developed to support families to care for their loved ones both in support services and financially, which I believe would make it cheaper and more effective in the longer term. I believe this would assist in releasing housing, assist families to take relative in at times of acute need and make it financially advantageous and not onerous on them – especially in these times of austerity in public services, jobs and pay rates.

    This is only really a sketch of what I would like to see. I am not an expert so do not have the ability to suggest detailed structures etc but I really hope something community and democratically accountable can be implemented sometime in my life time.

  4. Paul Bell says:

    Social enterprises, mutuals and co-ops is privatisation. I want the NHS to be an NHS.

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