The former NHS London chief executive has said Andrew Lansley damaged patient care by halting the capital’s large-scale service change programme.

Dame Ruth Carnall, who led the strategic health authority until its abolition at the end of last month, said Mr Lansley’s action in 2010 was a “bitter blow” to her organisation.

She said while the Healthcare for London programme would not have achieved all of its aims in the time it had lost because of his move, it had “slowed” the “measurable progress being made”.

Dame Ruth made the points in the foreword to a review of the flagship project, published this week on

NHS London chair Sir Richard Sykes and four other non-executive directors resigned in response to Mr Lansley’s halting of the work, which came weeks after the May 2010 general election. Mr Lansley said at the time the move was necessary because of a lack of engagement with GPs, patients and local authorities.

Dame Ruth also said it was a tribute to the clinical support the programme enjoyed that some of the work went on despite his announcement.

Healthcare for London was initiated in 2007 under the leadership of Sir Ara Darzi, now Lord Darzi. Plans before spring 2010 called for service closures at Whittington and Kingston hospitals, alongside a raft of other measures including stroke and trauma networks and the introduction of polyclinics.

The report, written by four former NHS London managers, said although hospital reconfiguration programmes stalled, “momentum was so powerful that London’s clinical leadership was clear that none of the [other] service transformation programmes under way should be abandoned”.

The report says that while the programme’s overhaul of stroke and trauma care, with the introduction of networks, had been a success, attempts to reform primary care had not.

The authors interviewed many of the managers involved with the process, who said the centralisation of decision making helped the changes.

One senior manager said: “If we had allowed a bottom-up approach to stroke, we would have a very large number of quasi hyper-acute stroke units now, and they would not be distributed around London in a way that facilitates equal access.”

The document reveals some of the compromises which had to be made in the creation of stroke and trauma networks.

One manager involved said if the locations of London’s eight hyper-acute stroke units had been made on the basis of units’ service quality alone, there would have been areas of London not served by one. The report admits: “This possibility had not been explicitly planned for by the project team, necessitating some difficult decisions.”

The “lessons learned” section of the report said overall Healthcare for London had “prioritised doctor leadership”. But it said the “clinical leadership pool could be relatively shallow” and quoted a senior NHS executive who said he had “paid people [to take part]… because that enables people to engage who otherwise would be restricted”.

The report also stressed the importance of creating dedicated project teams, rather than expecting staff to undertake major change programmes on top of their day job.

Asked to comment on Dame Ruth’s criticism a Department of Health spokeswoman said: “Changes to the NHS need to involve local people and be supported by clinical evidence. The reforms give doctors and nurses the freedom and power to provide the local health services their patients really need - making the decisions which were previously taken by managers.

“Now those who have regular contact with patients and know what they need best of all are in charge of making the changes that will improve the health of their local populations.”







The DH did not want to comment.


Exclusive: Healthcare for London review