Controversial London reform left on knife-edge

The NHS in the capital – where there have been glaring problems with care and productivity for years – has well developed plans for moving activity out of hospitals to networks of GPs and health centres.

But the prospect of closing accident and emergency and obstetrics units sparked outcry ahead of the election, fuelled by political battles around inner-London marginal seats, even before plans had been agreed or published.

Kingston and Whittington hospitals were particular flashpoints. Their local seats remain marginal with contests involving the three main parties.

Senior sources in London told HSJ they accept major changes need political support so, with a change of government, will have to be open to alternatives to their approach so far. They plan to press on with primary and community improvements, including 30 new health centres – now unlikely to be known as polyclinics – this year.

One said: “We have to do it with political support so we have to recognise some things will change.

“We are not wedded to the detail but the theme of localising where you can and centralising for better outcomes [will remain].”

Plans for north east London have already been published and referred to the Independent Reconfiguration Panel. Sources said political “paralysis” could see them “kicked into the long grass”, but others suggested they would survive. Most MPs there are safe.

Sources said delays to major change would see some London hospital trusts go into deficit, potentially as early as this year, as commissioners use strengthened powers to withhold payment for emergency care. Without reform London as a whole may face deficit in 2011-12.

If trusts run out of money they may decide themselves to run down and close loss-making services. Sources said this would be a risk to safety and, as a route to change, less likely to improve services than clinically led reconfiguration.

Other commissioners in the capital said they were used to uncertainty and change would go ahead. One said: “We have been progressing [reform plans] for the past two years in the knowledge we were in the run up to an election. Commissioners and providers need to continue working hard with local politicians and communities to explain why change is urgently needed and involve them in shaping the change.”