The NHS in London faces a “strategic vacuum” with no clear lead to drive through change, The King’s Fund has said.

According to the health charity, the NHS in the capital warned there could be a vacuum in responsibility co-ordinating health services and urged the government to spell out who will be responsible after the abolition of the strategic health authority, due in April 2013.

A report published today by the charity - titled Improving Health and Health Care in London: Who will take the lead? - warns London’s NHS could face severe financial difficulties over the next few years.

The charity said there are still large health inequalities in the capital, and GP performance is often poor with people’s satisfaction with GP services lower than elsewhere in the country.

It said 18 hospitals are forecast to have a net deficit of around £170m by 2014, and many London trusts will struggle to meet the government’s deadline to become foundation trusts by 2014.

Only 16 of 42 London trusts are currently foundation trusts, with around half of the remainder unlikely to be financially viable in time to meet the deadline, the charity said.

The report says necessary changes will not be driven forward unless it is clear who is responsible for overall leadership and co-ordination.

Chief executive Chris Ham said: “London’s NHS is in urgent need of change, but the risk is no one will be behind the wheel to push through the changes needed to improve patient care.

“New pan-London health organisations are emerging but none has a clear mandate to take the lead.

“Strategic leadership is important across the NHS, but in London it is particularly important as the challenges are more acute and urgent.”

The charity said problems remain, despite improvements under the Healthcare for London programme developed after NHS London, the strategic health authority, asked Lord Darzi to create a five to 10-year strategy for London’s NHS. But the programme was scrapped in 2010.

Lord Darzi echoed concerns over a “leadership vacuum” in the capital. Writing in the Times, he said: “Having an organisation that could take an overview of London’s health system was extremely valuable in leading complex changes involving powerful, well-established hospitals.

“NHS London will cease to exist as part of the current health reforms going through Parliament. This will leave a leadership vacuum.”