Letter: Political courage will resolve the NHS problems in London

Sir:The furores over the future of the NHS in London should not be allowed to distract attention from, or prevent the implementation of solutions to London's long-standing problems - widely recognised for over a century - which have remained largely unresolved for lack of political courage.

Both the diagnosis of London's ills and the broad character of the appropriate remedies ought to command cross-party support, despite the undoubted truth that changes of the magnitude that have become necessary are bound to offend specific institutional loyalties. A failure of nerve at this stage can onlyensure that the problems will intensify and postpone a solution. A solution postponed is bound, moreover, to be a solution that will be more radical.

The essential problems are these. London's acute hospital services are located where the people they once served are mostly no longer living. The health authorities and GPs who purchase care for their patients are increasingly choosingother locations for much of the care needed by the people they serve. Community-based servicesfor people with mental health problems and learning difficulties, and the frail elderly, are grossly inadequate. And the great medical schools are not nearly well enough integrated into London University.

Most of these problems were identified as far back as 1892, by a Select Committee of the House of Lords. They were also thoroughly diagnosed by the King's Fund Commission Report of 1992 (London Health Care 2010), which I advised and whose conclusions I supported, and which preceded the Tomlinson Report.

I hope that politicians of all parties can focus not on the past, nor encourage complacency about the present, but rather address the issues of the future patterns of care that are so urgently needed, the transitional strategies that are needed to minimise disruption, and the levels of funding that will be required both to enable the changes to take place in the short to medium term and to develop the much-needed support of care in community settings.

The detailed diagnoses have been made. The necessary changes can now be accomplished, and the progress of change itselfmanaged in a sympathetic and civilised fashion, given the right spirit on all sides. We are on the threshold of a great success story that will secure both a decent health service for Londoners and the future reputation of medical education and research in the capital.

Let the chance not be squandered on thetrivial ground of dissatisfaction with the presentation of the strategy, or the spurious ground that problems ignored are problems solved. The odds that we shall have a future secretary of state with the vision, ability and willingness to grasp these nettles are probably as low as they have been in the past so, for those who really cane about London, this may be the only chance they have.

Yours faithfully,

TONY CULYER

Department of Economics

and Related Studies

The University of York

Heslington,

York

7 April