London Eye: Who gets what care

Hounslow and the NWL masterplan

Hounslow is one of London’s poorer boroughs, Richmond one of the richest, and the needs of their populations are quite different.

When Hounslow and Richmond Community Services Trust was formed in the previous decade, London Eye heard from a Richmond GP who described their role in commissioning these services as preventing the new organisation transferring its resources to the area of greatest need (Hounslow). It’s not like there was no community care required in the richer bit, just that an organisation serving both would want to help those in greatest need first, and they were in Hounslow.

So although it can sometimes feel a bit arcane to those on the shop floor, organisational boundaries matter and affect who gets what care.

The south west London GP commissioner won’t need to worry much longer. Kingston Hospital FT is set to take over Hounslow and Richmond Community Services Trust and stop providing the services in Hounslow.

So who will run those services?

North West London Integrated Care Board is looking for a temporary provider from June until the end of 2025-26, and said at the moment there was only one suitable provider.

This is likely to be Central London Community Healthcare Trust, which already runs the services in every NWL borough except Hounslow, Ealing and Hillingdon – the latter two provided by West London Trust and Central and North West London Foundation Trust (both primarily mental health trusts) respectively.

After that, Richmond community services will likely be folded into the NWL mega-plan, namely just one acute hospital provider; and one community and mental health provider.

With the two mental health trusts looking likely to merge, and both now having a board in common with CLCH, this looks like the direction of travel – although the timings in the Hounslow contract suggest it’s planned to start no earlier than 2026-27.

Will other parts of London do the one-big-acute-organisation/one-big-everything-else-except-primary-care-organisation?

If NCL goes this way, it maybe doesn’t make sense to keep CNWL running the community services in Camden, as they do at the moment (and it’s the only one of the five NCL boroughs that doesn’t have these services managed by the acutes or CLCH).

Why does it matter? Because there’s the perception that, when they are brought together in the same organisation, hospital services will always be prioritised over their community counterparts, although no one has levelled this charge in NCL specifically.

Big appointment for King’s

The announcement that Sir David Behan will be the chair of King’s College Hospital was notable for a few reasons.

This is the organisation’s first substantive chair who was not shared with neighbours/rivals Guy’s and St Thomas’ since 2019. The previous substantive incumbent Ian Smith was sent in after the trust went into financial “special measures” and the chief executive had resigned.

The chair before him, the late Lord Bob Kerslake, also resigned, saying the financial architecture of the NHS was why KCH had had to announce a nine-figure deficit.

It often seems to fall to KCH to expose some of the underlying contradictions and illusions of NHS finances, not least the actual cost of providing highly specialised services.

It is perhaps no surprise that a review of devolved specialised commissioning and how it might work in south London found a lot of work still to be done. (As one manager put it to London Eye, “specialised commissioning remains a mess – a good idea that has fallen apart because the financial exposure is tricky”.)

While still in financial measures, KCH was given the same chair as GSTT, unprecedented for an institution the size and heft of King’s. But Sir Hugh Taylor was considered a success at King’s, having chaired GSTT for a long time prior.

But Charles Alexander, a former Royal Marsden chair, resigned from the Denmark Hill post in January after the latest financial blackhole was revealed. He remains chair of GSTT but it seems there is a limit to the size of combined organisations — and combined problem-solving — you can expect one person to oversee.

Sir David seems to be considered a good appointment locally.

One King’s person told London Eye there was some concern about appointing another white man to the post, but relief that it’s someone just for King’s, and who’s seen as a big hitter.

London Eye understands Sir David applied last time but NHS England went with the joint appointment instead.

He was also welcomed by people I spoke to in the wider system, who thought he might be more focused on the money than his predecessor.