Our Vision: For London

Our Vision
for London
The next steps on our journey to becoming the healthiest global city
OUR VISION FOR LONDON 1
Contents
Foreword: Our Shared Vision 4
1 Our shared ambition is to make London the healthiest global city 5
1.1 London has a unique combination of assets which give our city the potential to be the
healthiest global city 5
1.2 We have made progress, but significant and complex challenges remain 6
1.3 Transforming the health of Londoners is complex and requires a partnership approach 7
2 Our approach will focus on people, places and the emergence of population health systems 10
2.1 We will work with Londoners to develop more holistic support throughout a person’s life 11
2.2 We will focus on people, places and integration to improve health for all local populations 12
2.3 We will focus on ten specific issues as priorities for citywide partnership action 13
3 Our next steps to make joint working and integration a reality in London 15
3.1 Accelerating integrated working to deliver a new approach to population health improvement 16
3.1.1 Supporting joint working and integration in neighbourhoods 16
3.1.2 Supporting joint working and integration in boroughs 17
3.1.3 Supporting joint working and integration within sub-regional systems 18
3.1.4 Supporting joint working and integration through citywide partnership 20
3.2 Continuing to make progress in addressing ten issues requiring specific citywide action 21
2
4 Our more detailed plans for action 23
4.1 Accelerating integrated working to deliver a new approach to population health improvement 23
4.1.1 Creating the conditions for improvement: taking action to attract, train and retain the
workforce that we need to transform services 23
4.1.2 Creating the conditions for improvement: reimagining the health and care estate and
rethinking how we develop them together 24
4.1.3 Creating the conditions for improvement: making the most of opportunities created by
digital transformation, whilst bringing the public with us 27
4.1.4 Creating the conditions for improvement: establishing the right type of partnership
working and collective oversight 31
4.2 Continuing to make progress in addressing ten issues requiring specific citywide action 33
5 Our request of you: tell us what you think, and tell us how you would like to be involved 54
6 Abbreviations 55
7 Glossary A-Z 56
8 References 62

Foreword: Our Shared Vision
London is a major global city that is dynamic and Building on significant work between our
diverse. Like many big cities, London offers a wealth organisations over several years, this document
of opportunities for people to lead healthy and happy sets out our vision for the next phase of our joint
lives, but it also presents issues and challenges to working. It reflects the Mayor’s Health Inequalities
health. In London, where there are significant and Strategy, London Councils’ Pledges to Londoners,
persistent inequalities, these issues and challenges the Prevention Green Paper and the NHS Long Term
are experienced most by those in our most deprived Plan. We share our thinking on ten key areas of
neighbourhoods and communities. That is why focus where we believe partnership action is needed
concerted and coordinated efforts are needed across at a pan London level. This includes issues such as
public services and wider society to make the most of air quality, mental health and child obesity, and we
opportunities for good health, and to tackle the issues set out our ambition for deeper and stronger local
that cause poor health. collaboration in neighbourhoods, boroughs and
sub-regional systems so that services are genuinely
integrated, and Londoners can start well, live well
Our partnership is made up of the Greater London
and age well. This Vision is not a description of the
Authority, Public Health England, London Councils
multitude of actions that are taking place locally, nor
and the National Health Service (NHS) in London. It
a population health plan, rather it sets out the areas
exists to provide coordinated leadership, a shared
where our shared endeavours seek to complement
ambition to make our capital city the world’s
and add value to local action.
healthiest global city and the best global city in which
to receive health and care services. We recognise that
no single organisation can achieve this alone, and We see this as a milestone, a point in our partnership’s
that shared action makes us greater than the sum of ongoing journey to improve health and care outcomes
our parts. We have formed our partnership in order for Londoners. We are publishing it now as an
to address priority issues that require pan London important invitation to you – professionals, partner
solutions, to support pan London actions that enable organisations, the community and voluntary sector
more effective and joined up working at the level and members of the public – to discuss and debate it
of the neighbourhood, the borough and the sub- with us. We not only want you to tell us how we can
regional system, and to make the most of the very refine, develop and strengthen our proposals, but to
direct social, economic and environmental roles we help us deliver this vision so that we can work towards
each play as major anchor organisations in London. ensuring a healthy future for all Londoners.
Initiatives such as the Thrive LDN mental health
movement, child mental health trailblazers, School
Superzones, and the London Estates Strategy show
just what can be achieved when we work together.
Sadiq Khan Cllr Raymond Puddifoot MBE Sir David Sloman Prof. Paul Plant
Mayor of London London Councils Executive Regional Director, Interim Regional Director,
Member for Health and Care NHS London Public Health England
4
1 Our shared ambition is to make London
the healthiest global city
This section outlines the unique opportunities and bringing both new opportunities and challenges for
challenges for the health of Londoners that arise in our communities and services. Our diversity is our
a global city. We state our ambition for London to be greatest strength. Londoners take pride in being
the healthiest global city, and the best global city in the most multi-lingual city in the world. Londoners
which to receive health and care services. We reflect are proud of London – 81% of Londoners say they
on features of a city that contribute to health and belong to the city, with black, Asian and minority
wellbeing, our progress to date and the persistent ethnic Londoners reporting the strongest sense of
health challenges London continues to face; and the connection, and 75% of people say they belong to
ongoing need for strong partnership to make a real their local area.
difference for all Londoners.
The economic power of London influences other
1.1 London has a unique combination of economies across the globe. However, the story of
London is also one of stark inequalities. On average,
assets which give our city the potential to the poorest 10% of households in London have a
be the healthiest global city weekly income that is almost ten times lower than
the richest 10% of households, and households in
Cities play an increasingly important role in the world London’s bottom decile are comparably poorer than
and in our individual lives. They are already where other regions in England9. Deprivation still affects
most people live, and by 2050 almost 70% of the millions of Londoners and has a negative impact
world’s population is expected to live in a city1. on people’s ability to lead happy and healthy lives.
This must change. If London is to have a bright and
sustainable future all of our residents must thrive.
For the 8.9 million people living in London, which
The power of a city is in its people, and a population’s
is 16% of England’s population, the benefits and
greatest asset is its health. We want to increase the
challenges of an urban environment can interact in
years of life that people live in good health, and
complex ways. For residents – and for the additional
reduce the gap in healthy life expectancy experienced
2 million commuters, students and visitors who
between the richest and the poorest in our city.
travel into London on an average day2 – the urban
environment can provide many things that keep
people healthy and well. This includes diverse Ill health creates barriers for people trying to access
neighbourhoods and communities and opportunities the city’s many opportunities, to see friends, support
for learning, jobs and income. Unsurpassed in its their family and feel part of their community. Poor
educational and cultural offer, London is home to health can make it difficult or impossible to work,
excellent universities, four of which rank in the top 50 and means employers lose good people, talent
in the world3; it is recognised as a global capital for and creativity. If we do not address the conditions
arts and culture4; and it is the first National Park City that lead to poor health or take opportunities for
with green spaces covering over 47% of the capital5 prevention and early intervention where we can, then
with an ambition to make more than half of the people’s need for support becomes more complex
capital green by 2050. However, cities can also be an
unhealthy environment. Noise and air pollution make
some people feel unsafe; and a busy and sometimes
transient place can be stressful and isolating6.
We have a growing number
London, like all cities, is dynamic and diverse. One in of people over 65, forecast to
four Londoners is aged under 20, and the working
age adult population has grown by 10% over the
grow by more than 60% by
last decade, which is five times the rate across the 2040, compared to 41% in the
rest of England (2%)7. We have a growing number of
people over 65, forecast to grow by more than 60%
rest of England
by 2040 compared to 41% in the rest of England8,

and enduring. Any opportunity missed is someone’s the Ultra Low Emission Zone (ULEZ), and banning
potential unfulfilled. unhealthy advertising across the TfL estate. Similarly,
while every borough has its own priorities based on
the vision of its elected councillors, developed with
Health and social care systems are critical to
communities and businesses, and fulfilling its legal
maintaining the health of Londoners, but analysis in
duties, London Councils’ Pledges to Londoners set out
2010 suggested that access to healthcare services
commitments on pan-London priorities that address
may account for as little as 10% of a population’s
important determinants of health across the city.
health10. We cannot just rely on treating people when
they become ill. We know that many of our day to day
behaviours – such as what we eat and how physically 1.2 We have made progress, but
active we are – are important in maintaining our
significant and complex challenges remain
health and wellbeing. These factors are strongly
influenced by our physical and social environment,
and we know that the health burden of harms like The Global Burden of Disease analysis gives us a rich
poor diet, tobacco and alcohol fall disproportionately understanding of the causes of disability and death
on the most disadvantaged in our communities. Adult in London. Progress has been made in reducing
Londoners who are employed in routine and manual risks associated with tobacco, diet, blood pressure
jobs, and those who have never worked or are long- and cholesterol, and there is evidence of improved
term unemployed, are more likely to smoke than life expectancy and infant mortality in London. Life
the national average. Furthermore, alcohol related expectancy here has improved more than the rest of
hospital admissions for Londoners are higher in the the country. For males, it has risen from 76.0 years
most deprived areas. in 2001-03 to 80.5 in 2015-17, whereas for females it
has increased from 80.8 to 84.3 years over the same
period. Infant mortality has decreased by more than a
We also need a shift in emphasis and resources
third11. However, this masks significant and persistent
towards understanding and preventing the root
inequalities. There are signs that this progress is
causes of ill-health and tackling health inequalities.
beginning to stall in some London boroughs and,
This means thinking about the places where people
despite progress, London lags behind other parts of
are born, live, work and age; how we value diversity
the country on key public health outcomes, including
and difference in our communities; and the roles
child obesity and homelessness.
that friends, families and communities play. The city
as a human-made environment provides a unique
opportunity to shape our own future by designing There are significant and sometimes widening health
and building places that work for people, supporting inequalities in London. The cumulative effect of
good health in a sustainable way. The physical different forms of deprivation is a substantial cause
environment – our high streets, our ways of getting of this, as detailed in the Mayor’s Health Inequalities
around, our homes and institutions and the services Strategy. This leads to far shorter lives, lived in far
they provide – should enable all Londoners to thrive poorer health, often with multiple and complex
throughout their lives. co-morbidities and long-term conditions emerging
over a person’s life. For example, Londoners in the
poorest 10% are likely to have lives that are 4.9 years
Like many cities, London has a directly elected Mayor,
(women) and 9.3 years (men) shorter than those in
with a range of powers that allow him to play a key
the richest 10%12.
role in shaping the health of the city. The Mayor’s
Health Inequalities Strategy says that no Londoner’s
health should suffer because of who they are or
where they live. To support that ambition the Mayor
has chosen to put health and wellbeing at heart of
wider policy making. This includes Transport for
London’s (TfL’s) Healthy Streets Framework, the
London Plan, the implementation and expansion of
6
Figure 1: Top 10 causes of disability-adjusted life years in London in 2017 and % change 2007-2017, all ages13
% change
2007 Ranking 2017 Ranking 2007-2017
Tobacco 1 1 Tobacco -15.7%
Dietary risks 2 2 High body-mass index (obesity) 8.8%
High blood pressure 3 3 Dietary risks -7.8%
High body-mass index (obesity) 4 4 High fasting plasma glucose (blood sugar) 19.6%
High fasting plasma glucose (blood sugar) 5 5 High blood pressure -17.0%
Alcohol use 6 6 Alcohol use 0.8%
High LDL (cholesterol) 7 7 Occupational risks 3.8%
Occupational risks 8 8 High LDL (cholesterol) -18.5%
Air pollution 9 9 Drug use 5.8%
Drug use 10 10 Air pollution -9.5%
Metabolic risks Environmental / occupational risks Behavioural risks
Between now and 2035 London will see increases of over half a billion pounds (£540 million)14,15. This
of over 10% in the number of adults with diabetes, current shortfall in funding for children’s and adult’s
impaired mobility, hearing impairments, and personal social services will inevitably impact on the NHS if not
care needs, compared with 3% or less across England addressed. The number of working age adults with
overall. The prevalence of childhood obesity has social care needs is expected to rise disproportionately
remained persistently high in London, with 38% in London compared with England over the next few
of children in year 6 being overweight or obese. years. We need to work together in London, and with
Obese children are much more likely to stay obese national teams, to determine how to ensure sustainable
into adulthood and have poorer health, with the resourcing now and for future generations.
considerable impacts of this epidemic for the individuals
themselves, their families, the health and care system
Effective action needs to be taken to secure the
and the wider economy. Obesity currently costs the NHS
progress we have made for all Londoners, and to avoid
£6.1 billion per year nationally, and wider societal costs
escalating costs and demand that would place an
are estimated to total £27 billion per year.
unsustainable burden on local health and care services.
Funding pressures faced by local government are

significant. London Councils estimates that London 1.3 Transforming the health of
boroughs have experienced a reduction in core funding Londoners is complex and requires a
of over £4 billion in real terms since 2010 (a reduction partnership approach
of around 63%). This includes an estimated like-for-like
cut in public health spending of more than five percent;
The combination of challenges described above is
it means that children’s services in London faced a
not unique to London. It is being faced in most major
shortfall of £100 million in 2018/19, and by 2025 London
global cities. The World Health Organisation (WHO)
will have an adult social care funding gap in the region

says that communities, employers and industries are • The under 75 mortality rates for cardiovascular
increasingly expecting coordinated government action disease and cancer have declined and remained
to tackle the determinants of health and wellbeing, and stable for respiratory disease
to avoid duplication and fragmentation16. In response
to the 2014 Better Health for London report (BHfL), • Initiatives such as Stop Smoking London have been
the NHS in London, Public Health England, Health launched to support Londoners. Smoking rates
Education England, London Councils (representing have fallen to 13.9% in London (2018)
London’s boroughs), local borough partnerships, and
• London wide initiatives such as the Healthy
the Mayor of London collaborated to pursue shared
Workplace Charter have helped to support
aspirations for London.
prevention efforts, and three million working days
have been gained through a reduction in sickness
Our partnership is underpinned by a recognition that absence since the BHfL baseline (2012)
no single organisation alone can effectively address
the opportunities and challenges we face. Shared • A wide range of programme activity has occurred
action makes us greater than the sum of our parts. in relation to Londoners’ mental health, from
Our partnership has formed to address priority issues raising awareness and reducing stigma, through
that require pan-London solutions, and to support to early intervention and improving crisis care.
pan-London actions that enable more effective and However, there is more to do to address the
joined up working at the level of the neighbourhood, mental health and emotional wellbeing of children
the borough and the sub-regional system. We also and young people
work together to make the most of the very direct
• We have delivered programmes which empower
social, economic and environmental roles we each
Londoners to take care of themselves, including
play as major anchor organisations in London.
Good Thinking and Sexual Health London. Recent
efforts have also focused on expanding social
In a complex and adaptive system like London, it prescribing to tackle health inequalities and
has been challenging to deliver improvements in all increase the proportion of Londoners who feel
areas, and to deliver change at scale. There are good supported to manage their long term conditions
examples, such as the Great Weight Debate and
Thrive LDN, where citizens have been engaged and • Digitalhealth.London has linked digital health
encouraged to share their views on health priorities and innovators with health and care organisations,
the action to be taken. The review of Better Health for and the OneLondon collaborative was established
London demonstrated that through partnership working to help develop a Local Health and Care Record
at all levels of the system progress has been made: Exemplar (LHCRE) programme. We are building
a system where people can create and access
health and care information about themselves,
• The proportion of children who are school ready and where teams of registered professionals can
at age five has improved significantly, but progress access accurate information, drawn from all of the
on childhood obesity has been much more relevant care providers, to provide safe, effective
challenging to achieve and efficient care. The OneLondon programme is
recognised as one of the first five exemplar sites in
the country
Our partnership is • London was the first region nationally to offer

extended General Practitioner (GP) access in all
underpinned by a recognition of its local areas: 8am – 8pm GP access is now
that no single organisation available in every London borough. Further work
needs to focus on ensuring the quality of core GP
alone can effectively services, reducing variation, and improving the
address the opportunities primary care estate so that it is able to support
London’s emerging Primary Care Networks to
and challenges we face deliver a wider range of community based services
8
Figure 2: Summary of achievements and persistent challenges in delivering the Better Health for
London (BHfL) aspirations
Persistent challenges in delivering

Achievements against the BHfL aspirations
BHfL aspirations
10% increase of London’s children The proportion of children who are obese
achieving a good level of development by in Year 6 has increased by 2% since 2014,
the end of reception. This means that over and the overall proportion of children who
13,000 more children are school ready are overweight or obese has now
by age five reached 38%
Smoking prevalence in London adults has

seen a 3.3 percentage point reduction The proportion of adults who are physically
since 2014 (17.2% in 2014 to 13.9% in active in London is 65%, which is a lower
2018). This is equivalent to 124,000 than in 2015/16
fewer smokers
The mortality among adults with

The working days lost in London due to
severe and enduring mental illness in
sickness absence has decreased by 3
London is significantly higher than the
million days
national average
Extended 8am-8pm GP access is available

74.5% of Londoners are satisfied with their
in all London boroughs, resulting in an
GP’s opening hours, which is lower than
additional 100,000 appointments being
the national average
available each month
There is a 10% gap in mortality following

The mortality rate for causes considered
emergency admission to hospital between
preventable has declined in London, and at
those admitted on a weekday and those
a slightly greater rate than nationally
admitted at weekends
The proportion of Londoners who

60% of Londoners feel that health related feel supported to manage their long term
services engage Londoners in condition is 59%. London’s ambition to be
service design in the top quartile nationally has not
been met
Public Health England (2018) Better Health for London: Review of Progress
To help guide the next stage of our work together we accelerate health improvement, but the document is
are setting out a refreshed, shared Vision for London. not itself a population health plan.
This is underpinned by our respective and collective
responsibilities to make a difference to the health of
Our Vision for London is the start of an important
Londoners, the health and care services in London,
conversation about the way our partnership can
and to the way we collaborate. The document is
make the greatest improvements to the health of
focused on actions that need partnership and
Londoners and make London the world’s healthiest
coordination at a regional level. It is not intended to
global city. It provides purpose, a sense of urgency
cover every aspect of health improvement in London,
and direction, but it cannot yet provide all of the
or to act as a description of all actions that are taking
answers. In the next section we set out the approach
place locally. We are publishing the document to
to further strengthen and deepen our collaboration
enable discussion and engagement about how we
to improve the health of Londoners.

2 Our approach will focus on people, places and the
emergence of population health systems
In the last section we set out our ambition for London We want to make London a place where everyone
to become the healthiest global city, highlighting the can thrive, and people feel able to improve or
need for a partnership approach to make the most manage their health in the context of other aspects
of London’s array of assets and tackle inequalities to of their lives. We know that Londoners do not expect
improve the lives of all Londoners. this to be done to them but want to be involved
in the improvement of their health, services and
communities. Traditionally under represented
In this section we outline the approach we will take
groups must be given the opportunities to voice their
as a partnership to deliver progress towards our
views and be heard. Such targeted engagement was
ambition. The section introduces the concepts that
conducted by Thrive LDN, which highlighted that
will frame, guide and focus our actions together, and it
people want the following things17:
describes some of the principles, processes and people
that have been involved in establishing the actions
we now plan to take. These ideas and actions will be
explored in more detail in the rest of the document.
Help us as
residents to take on different
roles from supporters of initiatives, to health
champions and promoters of change
Support us to work in our communities to engage people at risk of

isolation and to build intergenerational and inter-cultural relationships
Inform us about existing initiatives and help us to learn from others
Adopt a more holistic and positive approach to mental health,

tackling the stresses that cause people to get ill – like poverty and
violence – as well as the symptoms
10
2.1 We will work with Londoners to • Co-produced – Londoners know their lives best.
We will work with citizens to design improved
develop more holistic support throughout
interventions
a person’s life
• Evidence-based – we will collect, and be informed
by, evidence at all stages of intervention whether
As core values underpinning our approach, our
design or deployment
partnership will continue to work in ways which are:
• Open – it is in everyone’s interests if we are
• Citizen-focused – focusing on what is important to transparent about what has and hasn’t worked.
Londoners not our organisations This will help other professionals learn from
each other, preventing duplication and hopefully
• Collaborative – we will work together across improving outcomes
organisational boundaries, listening to different
partners’ perspectives, skills and experience
Our approach will focus on the support people need throughout their lives. We want all Londoners to:
Start well Live well Age well
London is very diverse, and Londoners have a wide • Nurtures the people, places and partnerships that
range of health needs. Some people may have support wellbeing and health
infrequent or episodic need, whereas other people
live with multiple risk factors and health conditions • Fosters and develops integrated community-
requiring ongoing support and sometimes specialist based services that are accessible, proactive and
services. We know that risk factors and disease are coordinated
linked to the inequalities present in the city, and that
• Supports and sustains high quality specialist
too often the ‘inverse care law’ is evident, meaning that
services and networks that are available to people
people who live in more deprived areas have fewer
with acute and complex needs
health resources available to them18. Supporting all
Londoners to start well, live well and age well requires Figure 3 illustrates the framework to combine a
commitment to address these various needs and life-course approach with a commitment to local
situations. Therefore, we must think about our life asset-based local approaches, integration of
stages in the context of the neighbourhoods we live community-based services, and the maintenance
in, the services we rely upon, and the communities we of high quality specialist services. The framework
are part of. This means we need to work together to illustrates the scope of approaches we could be taking
ensure London as a global city that: and highlights the foundations needed to enable
better health and better health and care services.
These are explored further in the sections below.

Figure 3: Providing support across the whole life-course
Integration to
People, places and Collaboration to sustain
provide joined-up
partnerships to support high quality specialist
community based
wellbeing and self-care networks
services
Schools and health and care

Our environment, schools and Children and young people have
services work together to provide
communities promote and nurture access to high quality specialist
a seamless service and give
the health and wellbeing of all care, with safe and supported
families and children tools to
children and families transitions to adult services
Start well manage their own health
Our environments and local Londoner's have access to high

Early support for health issues is
communities help us avoid quality 24/7 emergency mental
consistently available and there
unhealthy habits and eliminate and physical health, alongside
is true parity of esteem between
homelessness and any stigma world-class planned and
physical and mental health
surrounding mental health specialist care services
Live well
Londoners are supported to As people grow older they are Hospital care is consistent, of high
manage their long term conditions supported in their community quality and safe and ensures
and maintain independence in with seamless care between Londoner’s can get in and out of
their community organisations hospital as fast as they can
Age well
Ensuring Londoners Digitally connecting
Enabled by:
are engaged in their London’s health and Developing Transforming
own health care providers London’s workforce London’s estate
2.2 We will focus on people, places social and physical capital. The integration of these
assets can generate health at different population
and integration to improve health for
levels, from the individual and their immediate
all local populations community, to local neighbourhoods and up to the
whole London population.
As the engagement from Thrive LDN shows, Londoners
want to be involved in developing improvements to To do this we need to think beyond the constraints of
their care. An assets based approach to population how services are currently funded and organised, so
health improvement recognises and builds on the that the various needs of Londoners shape the way
combination of human, social and physical capital that we collaborate across our public services and in our
exists within communities. An assets based approach communities. We have a shared belief that we need
can complement traditional public service models a radical shift towards more holistic and integrated
and enhance a person’s health despite systemic working. At the most limited this means much closer
inequalities19. London is a unique city made up of integration between health and care services, and at
communities with a varied abundance of human, its more expansive this means much stronger joint
12
working between local authority services, the local
NHS and civil society so that the full range of assets
in communities can positively impact wellbeing and
Professional expert panels
health. Through a more deeply connected way of have developed evidence
working we can more effectively tackle the things
that have the greatest influence on our health and
compendiums bringing
wellbeing, including housing, education, transport, together data analysis,
leisure services and employment, as well as the
delivery of health and care services.
research and case studies
from other global cities to
There is no “one size fits all” solution, but we should support each priority
work together using common approaches to deliver
consistently high standards of health and care across
the capital. Different areas will move at different
speeds, depending on local circumstances, but we will
2.3 We will focus on ten specific issues as
all be moving in the same direction. And, although
integration in local services happens at the local level, priorities for citywide partnership action
collaboration is needed at all population levels to
make it the norm across London. There are things There are some issues that demand collective
that are easier for local partnerships to achieve if action at a pan-London level to improve health
action is coordinated with other areas facing similar outcomes, either because they cut across our local
challenges, and there are some things that only neighbourhood and borough boundaries – for
regional bodies can do to create the conditions for example with air quality – or because there are
successful local integration. Without actively creating significant scope or scale benefits that emerge from
the conditions for joint working at local level we risk acting collectively. Within our partnership we have
making it harder for places to establish a population identified ten areas of focus for pan-London action,
health approach. having sought advice and evidence from more than
three hundred experts. While these ten areas are not
Our partnership needs to unlock opportunities for the only things that we will work on together, they do
better population health, working at the level of the represent a focus for collective action. This is because
neighbourhood, the borough, the sub-regional system we think that these are the issues that Londoners
and the pan-London level. But this will not be easy. care about, and where members of the partnership
London has some significant barriers to overcome have shared priorities, local and regional levers for
if we are to make systematic improvements. These change, a history or willingness for collaboration, and
include key workforce shortages, major financial a real opportunity to make a difference.
issues in some of our health providers, continued
budget pressures faced by local authorities and a Throughout the process, we have drawn from the
historic divide between health and care underpinned experience and expertise of London’s directors of
by legislation that can make joint working difficult. children’s services, directors of adult services, directors
However, together we have a real commitment to of public health, alongside clinical leaders from across
transform the way partners collaborate so that London the capital. Expert panels, drawn from the NHS, local
is a healthier place to live and to receive care. We want government and community organisations, have
to build on the progress already achieved in many of developed evidence compendiums bringing together
our boroughs and support all Londoners to benefit data analysis, research and case studies from other
from this type of joint working. Section 3.1 outlines in global cities to support each priority. Section 4.2
greater detail what we are planning to do, and section explores these issues in more detail, highlighting
4.1 illustrates how we will take action to support this some of the impressive work already happening, and
type of working across all areas of London. indicating specific actions that we will take next to
make further progress.

Figure 4: Identifying areas to prioritise for citywide action
Over 120 research

articles reviewed
360+ Over 50 metrics
collated across the
health and care different focus areas
professionals
engaged in the
development
Over 10 national Over 25 global
and regional cities reviewed
strategies analysed
170+ 70+
120+ NHS staff people from
local authority third sector and
clinical
leads, staff from partnership
operational
PHE and GLA organisations
leadership
Areas of focus for pan-London collaboration
1. Reduce childhood obesity 6. Reduce the prevalence and impact of violence
2. Improve the emotional wellbeing of children and 7. Improve the health of homeless people
young Londoners
8. Improve services and prevention for Human
3. Improve mental health and progress towards Immunodeficiency Virus (HIV) and other Sexually
zero suicides Transmitted Infections (STIs)
4. Improve air quality 9. Support Londoners with dementia to live well
5. Improve tobacco control and reduce smoking 10. Improve care and support at the end of life
To note: these pan-London actions will sit alongside and are complementary to action at the
level of the neighbourhood, the borough and the sub-regional system.
The principles and approaches outlined in this approaches are shared by London’s five Sustainability
section are explored in more detail in the subsequent and Transformation Partnerships, and they inform
sections. Because these are broad principles that the population health plans that are being developed
frame the actions across our partnership, these in each of those areas.
14
3 Our next steps to make joint working and integration a
reality in London
This section explores in more detail our vision for serve rather than focusing only on the treatment
the development of place-based, preventative and and care they deliver. Our ambition is to see these
joined up approaches to health and care. As well as arrangements fully established across London, with
working at a pan-London level, a key part of this is ICSs having in place inter-connected decision making
the development of Integrated Care Systems (ICSs) and service provision at three important levels:
in each of our five Sustainability and Transformation neighbourhoods, boroughs and the sub-regional
Partnership areas: North West, North Central, systems. This is illustrated in Figure 5, and we think
North East, South East and South West. London has this approach will help services to be planned in
organised health and care service development on a more coordinated and integrated way to meet
a sub-regional basis for many years and these five population needs, with joined up primary, community
sub-regional systems reflect the way that Londoners and social care acting as a foundation.
use the major hospitals and the city’s radial
transport networks. The move to ICSs will see NHS
The section then explores the ten areas of focus for
organisations increasingly working in partnership
citywide action, setting out the proposed measures
with local councils and others to take collective
that we will track and improve.
responsibility for the health of the populations they
Figure 5: Illustrating joint working and integration at different levels of our system
• 203 Primary Care

Neighbourhoods Networks with expanded
30,000-50,000 neighbourhood teams
population • Integration of community-
based care services
• Joint working across NHS

Place / borough and London boroughs
• Focus on population health
250,000-300,000 and inequalities
population • Providers collaborating to
coordinate services
• A single clinical
commissioning group
Sub-regional
for each STP, with a
system STP/ partnership board
ICS covering • Collaboration between
1.3m-2.1m acute care providers
population • Delegation of specialised
budgets and provision
• Action on pan-London
issues overseen by the
London Health Board
London regional • Creating the conditions
8.9m population for local integration and
local autonomy with
revised process of
oversight and assurance

3.1 Accelerating integrated working to
deliver a new approach to population Primary Care Networks will
health improvement
typically serve populations
of at least 30,000 but
3.1.1 Supporting joint working and integration
in neighbourhoods
more often closer to
50,000. They will be small
In London, the building blocks of integrated care will enough to be local, but
be the boroughs and the neighbourhoods within
them. We want to improve the collaboration between
large enough to support
staff working for different organisations, and with integrated multi-disciplinary
voluntary and community services (VCS) partners, to
ensure people receive coordinated support in the best
teams of professionals
setting for them, which is often in the community. This
will involve a variety of community based services,
such as social prescribing, debt and housing support,
smoking cessation, education and local authority other professionals such as clinical pharmacists and
community services. This is particularly important for nurse practitioners. Londoners will be able to access
people who have a range of complex health and care diagnostic services such as ultrasounds closer to
needs and for whom access to local community assets home, and as health information is joined up across
and civil society networks may be limited. multi-disciplinary health and care teams, people with
complex needs will receive a more proactive and
coordinated help without having to repeat their story
To support this integration, each neighbourhood will to lots of different professionals.
be served by a Primary Care Network (PCN). There
are more than 7,000 GPs working in London, across
1,200 GP practices. PCNs are new collaborations that PCNs will typically serve populations of at least
are built around groups of general practices working 30,000 but more often closer to 50,000 so they
together with a range of other local services, including will be small enough to be local, but large enough
pharmacies, social care and the community and to support integrated multi-disciplinary teams
voluntary sector. PCNs will be supported to offer more of professionals. At present, there are plans for
personalised and coordinated health and care to their 203 PCNs to be established in London. Through
local populations, including the more systematic use additional funding allocated in the NHS Long Term
of social prescribing. By working together, GP practices Plan, the NHS will invest an additional £400 million in
will find it easier to continue to offer extended hours, primary care in London over the next five years. Each
which in London has created more than 100,000 PCN will have a Clinical Director who will ultimately
extra appointments each month. And there will be join the broader leadership team for borough level
more options for residents who need support but health and care partnerships.
do not necessarily need to see a GP by employing
Establishing more collaborative ways of working is
key to ensuring that we can restore joy in general
practice, offer more to Londoners by broadening
There are more than 7,000 the skills and roles in our workforce, reduce the
isolation of professionals and practices, and make
GPs working in London, more intelligent use of technology and information to
across 1,200 GP practices provide a joined up health and care system.
16
3.1.2 Supporting joint working and integration in In North East London, ‘Tower Hamlets Together’
boroughs is a partnership of health and care organisations
where the council and CCG have established a Joint
Commissioning Executive with pooled budget and
At borough level our collective ambition is that there is a provider alliance arrangement for delivery of
providers of care services come together in integrated community services that involves social services, GPs,
care partnerships to join up care and remove acute trusts and the community and voluntary sector.
the historic barriers between care settings and
organisations. Our intention is that integrated care
partnerships include providers from primary care, In South West London the ‘One Croydon’ alliance
community care, mental health, social care and the operates a partnership between the local NHS,
voluntary sector. Some of our boroughs already Croydon Council and Age UK Croydon. Providers
have these partnerships in place and will seek to work together in confidential multi-agency huddles
formalise them through contractual arrangements, between GPs, social workers, pharmacists and other
using mechanisms such as alliance contracts or healthcare professionals, to discuss care plans for
Section 75 agreements. Others will create less formal over 65s and to determine the most appropriate
partnerships, underpinned by a Memorandum of interventions. As a result, Croydon has seen
Understanding, with a clear commitment to work unplanned admissions for the over-65 group fall by
together to improve population health. In time (and 15% against a rising trend.
subject to legislation), some of our providers may
wish to join together as Integrated Care Trusts. These examples illustrate the work across London
to explore models of health and care integration.
In South East London, Local Care Partnerships We expect a limited number of models to emerge
(LCPs) have been set up in each borough, including across London that are then tailored to suit local
‘One Bromley’ and ‘Lambeth Together’. Each LCP circumstances, ensuring that we have a clear and
has representation from acute, community, mental transparent way of working together whilst making
health, social and primary care professions, as well as sure arrangements make sense for local stakeholders.
the voluntary sector. Lambeth Together has enabled
provider collaboration such as the Lambeth Living We will continue to support these local approaches,
Well Collaboration, which supports multi-agency with an expectation that health and social care
working on mental health across the borough. budgets can be more aligned or blended, where
councils and CCGs agree this makes sense. Learning
from examples across London, and the rest of the
country, there are four major models that have
been shown to work individually or in combination.
Our ambition is for local partners in all of London’s
At borough level our boroughs to consider and establish:
collective ambition is • Voluntary budget pooling between a council and

that providers of care CCG for some or all of their responsibilities
services come together • Individual service user budget pooling through
in integrated care personal health and social care budgets
partnerships to join up • Oversight of a pooled budget and a joint-

care and remove the historic commissioning team for all adult health and
care services, by the NHS and at the request of
barriers between care the local authority
settings and organisations • The joint-appointment at the borough level of
a Strategic Director for local health and care

commissioning budgets, accountable to the Council
chief executive and the ICS Accountable Officer
(e.g. the Lambeth model) There are 36 provider
• Integrated leadership models across providers trusts in London, with
and commissioners, learning from the model in 19 acute hospitals,
Croydon – of joint-appointments across the CCG
and acute provider – and from the Salford and
10 mental health
City of Manchester models where council trusts, six community
staff are directly deployed within the Local
Care Organisations
trusts and the London
Ambulance Service
In addition, the leadership in each borough, at the
political and executive level, will have a central role
in the strategic direction of health and care services
and will be engaged in decision-making at all key
points. This will mean health and care partners
continuous improvement and the reduction of
setting specific priorities together regarding health
unwarranted clinical variation; to deliver the highest
inequalities and population health.
safety, experience and effectiveness of treatment;
and to safeguard the resources needed to sustain
3.1.3 Supporting joint working and integration such services now and for future generations. We
have seen important examples of clinical service
within sub-regional systems
consolidation in London, for example through
the reconfiguration of stroke services and the
London has some of the best academic health science creation of a single South West London Elective
centres, and the greatest concentration of specialised Orthopaedic Centre (SWLEOC). As a result of the
services, in the world. There are 36 provider trusts changes to London’s stroke services there have
in London, with 19 acute hospitals, 10 mental been significantly fewer deaths and shorter hospital
health trusts, 6 community trusts and the London stays20. And for SWLEOC, in place of four separate
Ambulance Service. These organisations already units that individually were struggling to meet patient
operate to provide vital local services, and many of expectations around access, the development
them provide more specialist services at sub-regional established the largest hip and knee replacement
level, such as major trauma and stroke services. centre in the United Kingdom (UK), performing
These services are necessarily planned across larger 5200 procedures every year with comparably high
geographical areas, and ICSs will have a responsibility performance on access and length of stay21. Similar
to work out how services are best arranged to meet consolidation has been undertaken in clinical support
the needs of the wider population being served. services, such as pathology, and there are trusts that
have progressed significant collaborations around
All trusts will be expected to collaborate to support corporate support services, such as payroll, human
innovation, productivity, specialisation and resources and information technology services.
consolidation. This will be important to ensure
18
Figure 6: Illustrating joint working and collaboration between providers of services
Clinically-led Whole System Pathways; Digital Innovation; Continuous Improvement
Mental Primary Community

Hospital 1 Hospital 2 Hospital 3 Health Care Care Social Care
Patient Care Patient Care Patient Care Patient Care Patient Care Patient Care Patient Care
Clinical Support Corporate Support
Pathology Pharmacy Imaging Payroll Bank & Agency IT
Endoscopy Other Private Patients Analytics Recruitment Other Corporate

Diagnostics and HR Support
Provider system able to be commissioned and funded on a population health basis
Proposals to make significant changes to clinical Londoners, and free up resources for reinvestment
services will take into account the Mayor’s ‘six in frontline care. To realise these benefits the NHS
tests’. These tests will ensure that system leaders commissioning landscape will need to change, with
have: considered the impact of changes on health CCGs consolidating to cover a larger geographical
inequalities; demonstrated that bed numbers are area. By April 2021, we expect that a single CCG
credible and take into account demographic change; will be established for each of the five sub-regional
identified sufficient capital and revenue funding; taken integrated care systems. Within this, delegation
into account the financial impacts of new pathways on models to borough partnerships are being developed.
social care services; demonstrated widespread clinical Our ambition is to delegate to place wherever this
support; and demonstrated widespread, ongoing and benefits local people, service users and carers, and
iterative public engagement22. where it will best deliver neighbourhood and borough
priorities whilst satisfying residents’ entitlements
through the NHS Constitution and Mandate. The
In addition, some population health system
consolidated CCGs will also be able to take strategic
management functions can also be better organised
commissioning decisions for services best delivered
on a bigger scale, for example by removing
across a multi-borough area such as acute and
duplication, streamlining activities and developing
specialist provision.
more sophisticated approaches to data, service
planning and system intelligence. This has the
potential to support more effective management Each sub-regional integrated care system will form
of clinical and financial risk; and to streamline an ICS partnership board. This will be where key
processes so that teams can free up time to stakeholders come together and take decisions
focus on the core job of improving services for on improving the health and care for the local

population. These boards will need to determine working, for example by establishing effective and
collective priorities, drive transformation, support shared mechanisms for oversight and support. There
improvement, and take action to reduce health are also opportunities to take a more coordinated
inequalities. As such, they will be empowered to make leadership and delivery approach for vital enablers of
decisions on investments such as capital and re- integration such as: the development of new primary
investment of savings made from integration across and community-based estate; the creation of better
the system. The partnership board will together data systems to support the availability of joined up
manage system financial risk so that the system information and the digital transformation of services;
operates within in its overall funding allocation. We and the coordination of action to attract, train and
also expect sub-regional system partners to agree retain our vital workforce. In addition, our partnership
how functions such as back office services, digital has identified areas of focus for citywide action,
infrastructure, workforce and business intelligence including issues such as the reduction of violence, the
are best managed across the wider system, with the reduction of suicides, and the improvement of care
intention to reduce duplicative overhead costs so that for people who are homeless.
they can be committed to fund frontline health and
care services.
We already have important examples of this type of
citywide collaboration:
3.1.4 Supporting joint working and integration
through citywide partnership • The London HIV Prevention Programme (LHPP) is a
London-wide initiative funded by local authorities
to promote prevention choices for Londoners.
At a regional level, there is a clear commitment
The LHPP works with partners to deliver sexual
to work closely across our partnership to provide
health promotion outreach to men who have sex
transformation and improvement support. Success
with men, and a free condom distribution scheme
will rely on forging close working with and between
across more than sixty venues in the capital.
local partners, supporting the development of
LHPP’s Do It London campaign has helped to
sub-regional ICSs, and enabling providers and
increase awareness of HIV, safer sexual behaviours
commissioners to take on increased responsibility for
and drive up rates and the frequency of HIV testing
making collaborative decisions for their population.
• Good Thinking is a pan-London initiative – driven
For regional partners in London, the vision is for as by local government, the NHS and Public Health
many activities as possible to be taken by sub-regional England – to provide a digital mental wellbeing
systems and boroughs, rather than the regional office. service. It has provided more than 300,000
For example, NHS London currently commissions Londoners with self-care support to tackle sleep,
specialised services, but many of these services – such anxiety, stress and depression. This powerfully
as inpatient mental health and radiotherapy – are part demonstrates multi-agency collaboration to meet
of pathways that are already commissioned by CCGs local need, innovation to use new channels to
in London. We want to support the delegation of these reach people we have not traditionally reached,
functions so that local commissioners and providers and an ability to influence the wider national policy
are able to play a leading role in planning how such agenda through the approach taken to the Every
services are delivered. Mind Matters campaign
Through the London Health Board, elected leaders,

There are also some big issues that we need to tackle health and care leads, and public health experts will
jointly at a citywide level. Strong collaboration will be continue to work together to drive improvement
needed to create the right conditions for local joint in health outcomes, health inequalities and health
20
services. The Board has a key role in facilitating London is learning from the approach of other global
partnership working between NHS bodies and local cities on how to measure and track improvements
authorities, and it can identify and help address new in the health of its citizens, and changes in the
opportunities and challenges as and when they arise. inequalities within the city. For example, Take Care
New York 2020 is New York City’s blueprint for
improving the health and lives of its citizens23. The
3.2 Continuing to make progress in City’s Health Department, in collaboration with
addressing ten issues requiring specific various partners, has created top priorities for each
citywide action of its communities. Progress against these goals is
reviewed annually.
Important and innovative work is happening across

London to make our city a healthier global city. The table below summarises some of the proposed
But more needs to be done, and this Vision is the measures that we want to track and improve for
beginning of a conversation to refine and focus the Londoners, taking citywide action. More granular
key actions that we now need to take as a partnership and specific detail on each of these issues provided
to move us closer to London becoming the healthiest in Section 2.
global city.
Table 1: Outcomes that we will track to determine the difference we are making for Londoners
Area of focus The outcomes we think we should track

Overall population • Average healthy life expectancy for London
health improvement
• The slope index of inequality (SII)
Reduce childhood • Reception: Prevalence of overweight including obesity

obesity
• Reception: Prevalence of severe obesity
• Year 6: Prevalence of overweight
• Year 6: Prevalence of obesity (including severe obesity)
• Reception: Inequality in the prevalence of obesity (including severe obesity)
• Proportion of five year olds free from dental decay
Improve the emotional • School readiness: the percentage of children achieving a good level of
wellbeing of children development at the end of reception
and young Londoners
• Number of schools with Healthy Schools London awards
• Number of early years settings with Healthy Early Years awards
• NHS Children and Young People Mental Health access
Improve mental health • Suicide: age-standardised rate per 100,000 population (three year average)
and progress towards • Adults in contact with secondary mental health services who live in stable and
zero suicides
appropriate accommodation
• Referrals Moving to Recovery for the Improving Access to Psychological
Therapies pathway
• Rates of detention under the Mental Health Act

Area of focus The outcomes we think we should track
Improve air quality • Percentage of London roads compliant with EU limit levels for Nitrogen Dioxide
(NO2)
• Meeting World Health Organisation (WHO) limits for PM2.5 concentrations by 2030
• Hospital admissions for asthma (under 19 years)
• Percentage of Londoners who report doing 20 minutes of walking or cycling on
the previous day
Improve tobacco • Smoking prevalence

control and reduce
• The difference in smoking rates of London vs national
smoking
• Smoking rates in pregnancy at the time of delivery
• Smoking rates among people working in routine and manual occupations
• Smoking rates in people with a serious mental illness
Reduce the prevalence • Violent crime (including sexual violence)

and impact of violence
• Hospital admissions for violence
Improve the health of • Number of people sleeping rough on the street

homeless people
• Statutory homelessness rate (per 1,000 households)
• Deaths of homeless people (experimental statistics)
Improve services and • HIV testing coverage

prevention for HIV and
• HIV late diagnosis proportion
other STIs
• New HIV diagnosis rate /100,000 (15 year old plus)
• Syphilis diagnostic rate /100,000
• New STI diagnoses (excl. chlamydia aged <25) /100,000
• Gonorrhoea diagnostic rate /100,000
Support Londoners • Dementia: Recorded prevalence (aged 65 years and over)

with dementia to live
• Deaths in usual place of residence: People with dementia (aged 65 years and over)
well
• Dementia: Residential care and nursing home bed capacity (aged 65 years and over)
• Place of death – hospital: People with dementia (aged 65 years and over)
Improve care and • Percentage of deaths that occur in hospital (all ages)
support at the end
• Percentage of people who have died that have a Coordinate My Care record
of life
• Percentage of population on palliative care register
We will continue to explore whether there are other

outcomes measures, designed by Londoners, which
could be used to track progress to see whether our
commitments are making a difference.
22
4 Our more detailed plans for action
The previous sections of this Vision have described how The London Workforce Board – which is made up
we intend to shift our approach to health and wellbeing of partners from across health, local government
for London so that it is more asset-based, proactive, and employer organisations – is proposing six key
and preventative. Delivering this change requires a commitments which will be championed by the board
shift towards more integrated working across the NHS and its member organisations. These priorities will
and local government at neighbourhood, borough and ultimately be aligned with the NHS People Plan and
system level. As described in the framework in Figure the local workforce plans in each of the five London
3, such a shift requires action on the things that enable Sustainability and Transformation Partnerships (STPs).
new ways of working, covering workforce, the estate, the
digital infrastructure and system leadership. This section
• Support the recruitment and retention of
of the document looks in more detail at the actions
health and care staff in the capital through
we plan to undertake to address these issues. It then
the schemes such as CapitalNurse. While there
explores in turn the ten areas of focus for pan-London
are more than 51,000 nurses in London, we have
action to highlight the granular and specific actions that
a nursing vacancy rate of 13.5%, which is higher
are already in progress, and our plans to go further.
than the rest of the country. Through CapitalNurse
These pan-London actions complement, and will sit
we have the vision to get nursing right for London;
alongside, actions at the level of the neighbourhood, the
highlighting the benefits of nursing in the capital,
borough and the sub-regional system.
developing career pathways in collaboration
with our higher education institutions (HEIs); and
4.1 Accelerating integrated working to creating nurse-friendly employment opportunities.
By 2024 we want to grow London’s nursing
deliver a new approach to population workforce by more than 8,000, and by 2028 reduce
health improvement London’s nursing vacancy rate by 5%. This ensures
London has the right number of nurses, with the
There is strong agreement that widespread right skills, in the right place, working to deliver
transformation in complex systems requires excellent care wherever it is needed
substantial leadership, local relationships, and local
• Mitigate the impact of the cost of living on the
design to improve services on the ground. These are
recruitment and retention of health and care
things that cannot be simply described and dictated
and staff. The cost of living in London impacts on
at a regional level. However, as a regional partnership
the recruitment and retention of health and care
we also think that local action is more likely to happen
staff. For example, 40% of London nurses say that
if we take shared responsibility for creating the
the cost of housing means they expect to leave the
right conditions for collaboration and integration to
capital in the next five years24. Our commitment is
happen. This enabling action needs to be felt within
to review the impact of the cost of living, specifically
neighbourhoods, boroughs and sub-regional systems.
transport and housing, on recruitment and retention
rates, and the options for mitigating this. This will
4.1.1 Creating the conditions for improvement: be followed by a series of cost of living pilots across
London which will be evaluated before support is
taking action to attract, train and retain the
provided to roll these out across the capital, and it
workforce that we need to transform services complements existing work to support employers to
meet London’s Good Work Standard25
An appropriately skilled and resourced workforce is
key to enable the change in the model of care, and to
ensure that core services are sustainable. We need to
support recruitment and retention of health and care
staff, specifically focussing on shortage occupations.
By 2024 we want to grow
London’s nursing workforce
by over 8,000

• Support the development of a multi-disciplinary • Commit to employing a workforce that reflects
workforce within primary care. Although GP the city’s diversity and fosters inclusivity of
numbers have increased there is a reduction cultures. The London Workforce Board will support
in the overall participation rate (the ratio of full partners and employers in achieving best practice
time equivalent numbers to headcount) and the in equality and diversity so that the health and care
nursing workforce is an ageing workforce. In workforce is reflective of London’s rich diversity.
order to create capacity to ensure that patients Opportunities to learn, develop and work in health
get the right care at the right time, it is necessary and care will be open to all, the experience of
to recruit and develop a multi-disciplinary working in health and care will be a positive one and
workforce. The introduction of the new GP particular support will be provided to individuals
contract includes funding for practices to form in underrepresented groups. Progress in achieving
Primary Care Networks (PCNs) and recruit more these aims will be monitored using measures
health professionals including additional clinical appropriate to the sector, acknowledging the
pharmacists, physician associates, first contact multitude of employers and employment methods
physiotherapists, community paramedics and
social prescribing link workers. By 2023/24 we want • Ensure the health and wellbeing of our
to grow the general practice clinical workforce by workforce so they can feel valued, and be
an additional 3,000 (>30%) health professionals. happy. Workforce shortages, rising patient
Progress will be monitored using the quarterly GP demand, and workplace bullying and harassment
workforce census are putting health and care staff under extreme
pressures, which is inevitably affecting patient care
• Build a workforce that is grown from the and the mental health of the workforce. We have
ground up in order to create a culture of a clear duty to care for our workforce. Over the
integrated health and care that encompasses next three to five years we commit to supporting
the local London communities. Within five years organisations and systems to develop staff health
all London trusts and STPs will have produced and and wellbeing improvement strategies that recruit
be delivering a strategy for developing healthcare and retain a healthy and happy workforce that is
professionals in their local community. Strong built around a culture of care. We’ll continue to
and sustainable local employment pathways will measure this through staff surveys, monitoring
need additional recruitment into social care, with staff sickness and benchmarking the ‘Freedom to
progression routes both within social care and into Speak Up’ marker for organisational health
health. Recognising the connection between health
and care progression routes would help develop
a positive pathway, clearer for residents and 4.1.2 Creating the conditions for improvement:
supporting both recruitment and retention reimagining the health and care estate and
rethinking how we develop them together
Decent, affordable homes are a key determinant

By 2023/24 we want to of health, and our neighbourhoods are places that
grow the general practice shape people’s health and wellbeing. They are places
clinical workforce by an where people come together to meet, to work, and to

make use of the community assets available to them.
additional 3,000 (>30%) It is here where much of the informal care exists,
health professionals which supports most people most of the time. And it
is also where some of our most important health and
care services are located.
24
At the heart of this vision is a shift towards more
integrated local working at the neighbourhood and
borough level. This requires us to reimagine the Overall, we estimate £8
primary and community care model, so that the
people, places and processes work together to help billion of new investment
Londoners to stay healthy, to connect with activities is required over the next
and groups within the community, and to access high
quality clinical services when they need them. This is a 10 years
better model for people who use those services, but it
is also a model that makes local care systems a more
rewarding place to work, ensuring that teams have
the facilities, infrastructure and relationships needed The Greater London Authority (GLA) and local
to do the job well. authorities have a range of powers, capabilities,
experience, local relationships and regeneration plans
that can, in partnership with the NHS, completely
London has some of the world’s most advanced transform our approach to the development of health
facilities, but it also has some of the worst GP and and care facilities. Examples of this type of working
hospital buildings in Britain. Some primary care are already available, such as in Lewisham, where
buildings are so dilapidated and inaccessible that they the council and CCG have been working alongside
have been deemed beyond repair: a third of London’s the GLA, the Local Government Association (LGA) and
primary care infrastructure needs to be replaced. Our the Cabinet Office – through the One Public Estates
ambition is not only to fix the roof in challenging times, programme – to develop neighbourhood care hubs
but to transform the health and care estate, so that in each of its four neighbourhood areas. This work
it works more effectively for communities, for service was identified as a devolution pilot with the aim of
users and for staff. Overall, we estimate £8 billion of establishing a Community Based Care model which
new investment is required over the next 10 years26. emphasises connections across communities and
better integration of health and care services.
Reshaping the care model will only happen if we
transform the buildings and infrastructure that Likewise, in Newham, a joint venture has been
supports it. More of the same is not the answer: established between the council and the local NHS
in the future we will need more neighbourhood- Trust, with the support of the CCG and primary care
based care hubs, not simply large medical centres. partners, with the aim of creating state-of-the-art
We need places where professionals can work facilities that combine traditional GP surgeries with
together collaboratively, where different public advanced medical, community, social care and mental
services can work side by side, and where residents health support, and reducing journey times for many
can make use of the space as an asset in their service users and patients.
community. And because such hubs sit at the
heart of neighbourhoods, these places are not just
about the provision of public services, they can These partnerships are possible, but we have
also be developments that support new residential heard that progress is often very difficult, and that
spaces, with an emphasis on affordable housing additional support is needed to make this easier.
and key workers. These need to be community-led We want local partnerships to be able to create
developments, rather than centrally specified and new neighbourhood care hubs. If there was one
overly prescribed buildings, and local elected leaders in each locality that would require approximately
and local government have a central role in shaping 80 developments across the city, which would be
the emergence of this infrastructure, in partnership the most ambitious redevelopment of health and
with the NHS, so that residents have access to 21st care infrastructure since the establishment of the
Century community assets. NHS. Over the next five years we would want to

demonstrate what is possible by working with at the ability for local authorities to borrow to invest in
least ten areas. Achieving this will radically upgrade public infrastructure – could be applied to accelerate
and transform the way that services work for local the development of new community hub facilities.
populations, but it will require regional action to We will also explore other practical challenges, such
create the conditions within which local partnerships as streamlining and simplifying the way practices are
find it easier to make progress. reimbursed for their premises. Our intention is then to
include in our investment pipeline the neighbourhood
care hubs to be delivered over the next five years.
To make that happen, the London Estates Board and
Alongside this work we will also establish a task and
the London Estates Delivery Unit will begin work to
finish project to identify the opportunities and barriers
explore the range of potential options available to
to implementing STP estate plans at a neighbourhood
enable the establishment of local community estates
level, proposing solutions that help develop the local
partnerships. In particular, we will explore how existing
capability and capacity needed for the transformation
freedoms – such as the transfer of assets from NHS
of local services.
Property Services, the repurposing of surplus land, and
Lewisham Newham:
• Lewisham Health and Care Partners, are • Health and Care Space Newham (HCSN) is a
working with the GLA, LGA and the Cabinet joint venture partnership between Newham
Office to enable the development of four Council and East London NHS Foundation Trust
Neighbourhood Care Hubs across the borough. (ELFT) to own and build integrated health and
These aim to supplement and not duplicate care facilities. It is the first such partnership
other care services, emphasising co-location between a local authority and an NHS FT in
or collaboration with other voluntary sector the country; and it is the delivery vehicle for a
support services. wider strategic partnership that includes NHS
Newham CCG and the GP federation Newham
• The hubs aim to be recognised as centres Health Collaborative. HCSN is a £200m venture,
which do as much to promote health, wellbeing underpinned by a business case which outlines
and self-care as to provide appropriate care for the operation of the partnership over the next
those with ill-health. 60 years.
• It is envisaged that the Neighbourhood Care • The vision is to develop state-of-the-art
Hubs will house integrated health and care facilities that combine traditional GP surgeries
teams, such as the Neighbourhood Community with advanced medical, community, social care
Teams and the community mental health and mental health support reducing journey
teams; provide touch down space for other times for many service users and patients.
local services, including the voluntary sector; The venture will also build new homes to
act as a base for local social enterprises; make working in the area more attractive to
support residents with help and advice for healthcare professionals who already work in
accessing digital services and making choices; Newham and encourage others to apply for
offer bookable space for shared use; and vacancies. Around 250 affordable homes will
provide urgent care and GP extended access be built as a result of the venture and will be
services for the community. allocated as a priority to key workers in the
health and care sector.
26
4.1.3 Creating the conditions for improvement: In the same way that the postal service has developed
making the most of opportunities created by a reliable approach to delivering mail to different
addresses by using a system of postcodes, we need a
digital transformation, while bringing the
secure and reliable way to move information between
public with us service users, professionals and organisations. This
will require us to develop digital infrastructure that
Our aspirations to create 21st Century public services enables the exchange of information in a timely
should not be limited to the development of physical way – just as the Post Office has done for letters
premises. Healthcare lags other industries in digital and parcels. However, to provide population level
maturity, and enhanced digital capabilities will be improvements, improve health and care services, and
essential if we are to: improve the experience of develop new or more targeted treatments, simply
care; empower people in managing their own health joining up information is not enough. We need to be
and wellbeing; improve the experience of staff by able to bring together the data from large numbers
reducing workload, offering more flexible working of people to provide new insights and understanding.
and strengthening teamwork; and deliver high This means having all of the relevant information in
value healthcare that improves the wellbeing of our one place, organised with standard references so
population and reduces health inequalities. To do that it is easy to find – a little like a research library.
this we need to unlock the value of information so This information needs to be held securely and only
that we can understand what is really happening available to those who have legitimate reason to use
for an individual, see and act on patterns across the it. It should also maintain people’s privacy by, for
population, and keep learning about what works. The example, making the data anonymous so that it is
marker of success in this vision is the emergence of a impossible to identify whose information it is.
learning health and care system that uses information
to achieve better and more equitable outcomes for Collectively, we will have to invest significantly in the
Londoners, whilst delivering affordability by driving technology and organisational change necessary
out duplication and unnecessary costs. Shifting to allow health and care services to make better
our approach will require collective action, public use of powerful emerging techniques made
involvement, and a focus on user-centred design. possible through the revolutions in genomics and
It will enable more personalised, proactive and data analytics. Fundamentally, this is an issue of
preventative services that are more convenient, operational redesign and standards setting, and it
more effective and more intelligent. requires ownership by the most senior leadership in
each organisation: it is not an Information Technology
Most Londoners believe that information about their issue. If we get it right, the opportunities promised by
health is already shared between the professionals digital transformation are great, and they shape our
responsible for providing their care and are surprised aspirations for London.
to know that, at present, we are unable to connect
their records between organisations48. The reality is
that the joining up of information in existing health
and care systems is inconsistent, cumbersome, and Healthcare lags
fails to actively support patient care pathways or
clinical workflows. It is still common for information to other industries in digital
be exchanged via post, fax, telephone and email. This maturity, and enhanced
impacts on the quality of care provision – reducing
the efficacy and safety of care, and resulting in a poor
digital capabilities will be
experience for patients and carers. essential if we are
to improve

• We want Londoners to feel confident about person’s symptoms and get a response from a
finding the right support to help themselves, and hospital-based specialist within 48 hours. This not
to engage in a different type of conversation with only fosters collaboration and problem-solving
the care professionals who support them. That is between clinicians, it also reduces some of the
why it is so important to continue to develop and stress and inconvenience for people having to
adopt digital support tools such as Good Thinking go to an outpatient appointment. It should also
and Coordinate My Care (CMC), both of which are make a significant contribution to reducing the
available for free to all Londoners number of journeys required for healthcare, with
a reduction in the harmful emissions that such
• We want Londoners to feel confident about travel generates
accessing services in different ways - not
necessarily requiring people to take time off work, • We want Londoners to feel confident that
or travel to their local clinic, but instead having the professionals are using health and care
choice to have conversations with clinicians over information intelligently so that they can spot
the phone, online or using video calls potential issues and offer early support, rather
than waiting for symptoms to develop and
• We want Londoners to feel confident that when progress. This will be vital if we are to deliver the
they receive care their clinical teams have the stage shift in cancer diagnosis, so that at least
right information at the right time to make the three-quarters of the Londoners who receive a
best decision; and that this is collected, stored and cancer diagnosis are diagnosed at an early stage
used in a secure way and in a way that safeguards and treatment can be started earlier. Similar
privacy appropriately. That is why we are building methods will also be important in providing
on existing local programmes, such as the East more tailored support to reduce the impact of
London Patient Record (eLPR), to make sure that heart disease, diabetes, kidney disease, stroke
all general practices, community services, hospital and dementia – which we know drive much of
services and mental health services in London can the ill health people in London experience. The
connect together to see relevant information about information revolution means we now have much
a person in their care. This is a core part of the first more intelligence on which to base targeted offers
phase of the OneLondon LHCRE programme of support, and Londoners should feel confident
that we are using this intelligence to provide the
• We want Londoners to feel confident that
most effective care at the earliest point
professionals in different organisations are
supported to share information and to work • We want Londoners to feel confident that local
together to resolve issues without always having services are planned and organised in a way that
to refer someone for an additional appointment, thinks about user-based design and considers the
resulting in additional delay and stress for real needs of the local population, based on actual
the patient. New tools, such as the Referral data. And to be confident that we are supporting
Assessment Service and the e-Referral Service research into the causes and treatments of illness,
Advice and Guidance, are supporting GPs and participating in the creation of new knowledge
hospital doctors to work together to resolve and treatments that will make a big difference to
issues and make sure any referrals to outpatients them, their families, and millions of other people in
are necessary and make best use of everyone’s London and across the world
time. It is now possible for a GP to describe a
28
This will only be possible if Londoners understand clinical services to provide more proactive and
why and how their health and care information is anticipatory care, and to act as a source of
used, trust that it will be used appropriately and depersonalised information for population health
in line with their expectations, and are supportive intelligence and public health research
of our ambitions. There are a multitude of factors
that have confused debate about uses of health • We will explore the future models of funding that
and care information in the past and the scope are required to create and sustain digital support
for misunderstanding and cynicism is therefore tools, like Good Thinking, CMC, or other personal
understandably high. We must address this risk by health and care records, so that all Londoners are
avoiding past mistakes. The most important factor will able to access effective digital support
be to create a wider understanding and confidence
amongst the public and care professionals. To create Our plans are ambitious and challenging, but they are
and sustain legitimacy and trustworthiness we must essential if London is to become the healthiest global
have a different type of conversation with Londoners city now, for all, and for future generations. Strategic
about people’s expectations, and we must ensure leadership will continue to be provided by the Chief
public services operate in line with these expectations. Digital Officer of the Greater London Authority and
the Regional Director of the NHS in London, with
Steps for further progress: appropriate collaboration and governance to make
sure we make a difference. To guide our efforts our
partnership will develop a Data Strategy and Digital
• We will continue to develop and integrate digital Declaration for London’s health and care partners.
support tools so that they are easier to access
and use
• We will continue to build on previous engagement

with Londoners, using discussion and deliberation To create and sustain
to explore and understand people’s expectations
of the use of health and care information legitimacy and
• We will continue the journey set out in our
trustworthiness we must
‘Smarter London Together’ roadmap to transform have a different type of
London into the smartest city in the world, conversation with Londoners
with coordinated efforts to promote MedTech
innovation to improve treatments in the NHS and about people’s expectations,
social care and we must ensure public
• We will continue to develop the Local Health services operate in line
and Care Record infrastructure – in line with
public expectations – so that it becomes a more
with these expectations
sophisticated data service platform to support
patients to access their own information, for

This will describe how we bring together academic,
public service and technology partners to act
Early detection of Acute Kidney collectively so that we can get the maximum benefit
Injury has been cut from hours for Londoners from the assets that we have in the
capital, and will build on the existing progress that
to minutes, reducing the cost has been made through the Local Health and Care
of care from £11,772 to £9,761 Record Exemplar, the Digital Innovation Hubs and the
London Office for Technology and Innovation.
for a hospital admission
Early detection of Acute Kidney Injury patients by speeding up detection and preventing
missed cases. Clinicians were able to respond to
urgent AKI cases in 14 minutes or less - a process
Detection of one of the biggest killers in the
which, using existing systems, might otherwise
NHS has been cut from hours to minutes at the
have taken many hours as clinicians would
Royal Free Hospital in London thanks to the
previously have had to trawl through paper,
introduction of a new digital alerting tool which
pager alerts and multiple desktop systems.
has been developed by technology experts at
DeepMind Health in collaboration with clinicians
at the Royal Free London NHS Foundation Trust This has improved the experience of clinicians
to help identify patients at risk of acute kidney responsible for treating AKI, and reduced the cost
injury (AKI). of care to the NHS – from £11,772 to £9,761 for a
hospital admission for a patient with AKI. Clinicians
involved in the evaluation said the new technology
According to the evaluation led by University
‘has definitely saved people’s lives’, and ‘it must
College London, and published in Nature Digital
save at least a couple of hours in a day’.
Medicine, the app improved the quality of care for
30
4.1.4 Creating the conditions for improvement: the London Health Board. This could include a range
establishing the right type of partnership of mechanisms, such as more direct involvement
of local government representatives in the NHS
working and collective oversight
regional executive structures, the inclusion of NHS
representatives within the collaborative structures of
The opportunities and structures for leaders to London Councils, and a refresh of the Healthy London
participate in making decisions are undoubtedly Partnership governance arrangements.
important within any partnership: they determine
the ability for different perspectives to be shared and
Partner organisations are working to establish
understood, for relationships and trust to develop,
integrated systems leadership at a sub-regional level,
and they act as the mechanisms through which
covering each of the five STP footprints, by April
partners can hold themselves and each other to
2021. These will each be supported by the creation
account for making progress.
of a partnership board (with an independent chair)
and an executive board at the STP-level. These new
As a regional partnership – of the GLA, London arrangements must engender stronger collaboration
boroughs, and the NHS – our approach to joint between health and social care commissioners, and
working must respect the different histories, statutory with providers, taking into account the democratic
bases, and lines of democratic accountability inherent and institutional realities inherent in place-based
within each member. Whilst recognising these leadership. These new structures are expected to
differences, we need to find effective ways of working oversee a movement towards place-based budgets in
together to transform outcomes for Londoners. At each borough, and to seek devolution of some NHS
all levels of the system this includes creating ways responsibilities from the regional level – such as with
to foster a consideration of ‘health in all policies’, to the devolution of responsibility for some specialised
engender collaboration in decision-making and to commissioning budgets. As these structures are
support shared oversight of joint working, whilst also established the regional NHS will work with ICS
enabling clear delivery through executive structures. leaders to co-design system-wide objectives. ICS
boards will be accountable for their performance
against these objectives.
At a regional level the leadership of our partnership
is enabled by and through the London Health
Board. It provides strategic direction and oversight Local authorities and the NHS are committed to
of progress against our collective commitments developing local proposals for integrating health and
by bringing together the most senior accountable care in each borough. Over the next five years our
officers for the NHS in London with representative ambition is for every borough to have developed
political and executive leaders from local government, place-based leadership arrangements with shared
and the GLA. The board meets in public and is accountability and pooled budgets for specific groups
chaired by the Mayor of London, with the role of of patients or people with similar needs. The specific
making the most of opportunities for partnership form and scope of these arrangements, and the
so that we make London the healthiest global city. pace with which they will be implemented, will be
We will explore how to strengthen our partnership determined locally with areas moving towards deeper
mechanisms for executive leadership, working into integration and risk sharing at the pace of trust.

Lambeth of functions to support those adults who are
experiencing mental distress or at risk of
experiencing mental illness and distress. The
Lambeth has created a collaborative health and
services include employment and housing
care partnership called Lambeth Together. The
support. Partners work together through a
aim of the partnership is to improve health and
formal 7-10 year alliance contract worth £67m
wellbeing and reduce health inequalities for
per annum which has been in place since July
people in Lambeth. To enable this, statutory,
2018, demonstrating a commitment to integrated
voluntary and community stakeholders
commissioning between health and social care,
and partners have come together to create
collaborative commissioner-provider working and
an environment where collaboration and
a co-productive approach.
integration is the way that things are done in
Lambeth. This includes formalised integrated
leadership arrangements across NHS and council Building on the experience and lessons learnt
commissioning, for example through the joint- from adult mental health, the next delivery
appointment to the role of Strategic Director: alliance will be for Neighbourhood Based Care and
Integrated Health and Care. Wellbeing – aligning neighbourhood developments
across different parts of the health and care
system including PCNs, neighbourhood nursing,
Lambeth Together is underpinned by a number
neighbourhood home care provision and VCS
of delivery alliances. The alliances enable groups
developments. The neighbourhoods are based
of providers to come together to look at the range
on populations of approximately 30- 50,000 in
of services that they provide and see how they
geographical areas.
can work better together to improve outcomes
in terms of population health, user experience,
worker experience and better value for money. Integration in Lambeth sits within the broader
South East London System of Systems
approach developed across South East London
The most advanced of these delivery alliance
partners as part of the development of their
is the ground-breaking Lambeth Living Well
wider ICS arrangements.
Network Alliance (LWNA). The LWNA has a range
32
4.2 Continuing to make progress in addressing ten issues requiring specific
citywide action
This section looks in more detail at the ten focus areas for action. The following summaries highlight
the outcome commitment we think would be important to make a difference to, the challenge we
face in doing that, the things we are already doing, the things we are considering doing next, and the
wider mix of measures that will help to tell us if we are making an impact.
Reduce Improve the emotional wellbeing of

childhood obesity children and young Londoners
Improve mental health and Improve

progress towards zero suicides air quality
Improve tobacco control Reduce the prevalence

and reduce smoking and impact of violence
Improve the health of Improve services and prevention

homeless people for HIV and other STIs
Support Londoners with Improve care and

dementia to live well support at the end of life

London Vision
Reduce
childhood obesity
Our ambition: every young

Londoner is supported to maintain
a healthy weight
The challenge
we face…
Our commitment: we will achieve
a 10% reduction in the proportion Around one in five (22%) of London’s 4–5 year
olds are an unhealthy weight, and by the time
of children in reception (age four they leave primary school aged 10–11 years
or five) who are overweight by old the proportion affected rises to two in five
(38%). This is the highest level of any region
2023/24, delivered through bold in England, and in some London boroughs up
citywide actions and targeted to 50% of children are affected as they head
into secondary school25,27,28,31
support for those most at risk
Over
20%
of children in Reception are Londoners have higher rates Obesity drives health problems
overweight or obese of unhealthy weight versus such as dental cavities, fatty liver
other global cities disease and Type 2 diabetes
Almost
40% Children who grow up in

London’s most deprived areas
are affected the most As an adult, there is increased risk
of children in Year 6 are
of cardiovascular disease, cancer &
overweight or obese
musculoskeletal disorders
34
Our actions so far…
• Supporting the Healthier Catering Commitment, • Restricting the advertising of unhealthy food
a scheme promoted by local authorities to help across the TfL estate
caterers and food businesses make simple,
healthy improvements to their food • Establishing London’s Child Obesity Taskforce,
convened with an ambitious goal to halve the
• Collaborating with health and social care partners, percentage of London’s children who are
including GLA, to School Superzones across the overweight at the start of primary school and
capital. These are zones around schools, around obese at the end of primary school by 2030, and
a 5-10 minute walk, to create healthier and to reduce the gap between child obesity rates in
safer places for London’s children and young the richest and poorest areas in London. They
people to live, learn and play have published Every Child a Healthy Weight: Ten
Ambitions for London which sets out an ambitious
• Rolling out Play Streets, a resident-led initiative call to action for partners to act through a whole
supported by councils in several boroughs. This system approach49
enables temporary road closures for a few
hours once a month so that children can play in
the road
• Implementing the Transport for London (TfL)

Healthy Streets Approach which focuses on
creating streets that are healthy places for
people of all ages to walk, cycle, play and
spend time. The Mayor’s Transport Strategy
includes a target for all Londoners to achieve 20
minutes of active travel each day by 2041
Our next steps…

• We will work with school leaders in London with • We will establish a London Childhood Obesity
the ambition for all schools to be able to become Delivery Board to consider and respond to the
water-only schools, building on other actions in recommendations of London’s Child Obesity
London to make NHS premises healthier Taskforce as part of the development of a whole
systems child obesity plan, as outlined in London’s
• We will develop specific proposals on ways that first Child Obesity Taskforce action plan
local communities can offer integrated, meaningful
support to families from the most disadvantaged • We will refine the incentives for hospitals to
backgrounds to maximise the impact of the encourage healthier food options to be available
National Child Measurement Programme process and to limit the proportion, placement and
promotion of foods high in fat, salt and sugar
• We will offer children and families targeted support
packages and access to weight management
services. Including NHS services treating children
for severe complications related to their obesity
(e.g. diabetes, sleep apnoea, poor mental health) to
prevent needing more invasive treatment
• We will support London’s Child Obesity Taskforce

in hosting the first global summit on child obesity
in September 2020. To collaborate with other
global cities to share and learn

London Vision
Improve the emotional
wellbeing of children and
young Londoners
Our ambition: every London child reaches a

good level of cognitive, social and emotional
development with effective child and The challenge
adolescent mental health services available to
all young people whenever they need them.
we face…
Young Londoners experience worryingly high
Our commitment: we will ensure access levels of poor mental health and frequently
face challenges when trying to get help.
to high quality mental health support for all Poor mental health is a cause of inequality
children in the places they need it, starting and disadvantage, as well as one of its
consequences. We need to design solutions
with 41 Mental Health Support Teams in with young people50,51,52,53,54,55
schools, maximising the contribution of
the Mayor’s/GLA’s Healthy Schools London
Programme and Healthy Early Years London
Programme, and extending the use of digital
support technologies.
1/2 13% 123

of all mental health problems of 15-18 year olds have a schools are an effective setting to
manifest by age 14 and 75% mental health disorder offer interventions for low levels
by age 24 of mental health need
35% 30.5% Poverty, neglect, ethnicity, domestic

violence, being a looked after child,
being from the LGBTQ+ community
of young Londoners surveyed Although treatment access rates and many other inequalities can all
would feel most comfortable for children and young people have lead to poor mental health
getting support online improved, they are still just 30.5%
36
• Investing in children and young people’s • Convening the annual young Londoner-led
mental health services to achieve the national mental health event led by The Mayor’s Peer
access target of meeting the needs of at least 35% Outreach Team and Thrive LDN
of children with a mental health conditions by 20/21,
and contributing the national target of an additional • Offering grants to increase social action in young
345,000 young people aged 0-25 by 2023/24 Londoners at greater risk of poor mental
health, through Young London Inspired - a joint
• Investing £31m in mental health support teams Thrive LDN and Team London programme
in schools, aiming for 41 teams in place across
London by 2024 with teams in each STP area • Sharing learning from the Young London Inspired
programme to encourage volunteering as a
• Promoting the GLA’s Healthy Early Years and route to improving wellbeing for young people at
Healthy Schools London programmes to support risk of mental ill health
early years settings and schools to support the
emotional wellbeing of children and families
• Training a mental health first aider for every

London state-funded school and college by
March 2021 – funded by the Mayor
Our next steps…

• By the end of 2020/21, there will be 41 Mental Health in the GLA’s Healthy Schools London and Healthy
Support Teams operational in London, delivering Early Years London programmes, and promoting
evidence-based interventions for children and young mental health first aid training, suicide prevention
people with mild-moderate mental health conditions. training, and access to digital support technologies
This represents an investment in excess of £25M.
We are working with local areas to expand further, • We will extend the Good Thinking digital wellbeing
aiming to meet the NHS Long Term Plan ambition service so that it meets the needs of young
of 25% coverage by 2023. This supports our London Londoners aged under 18
ambition to ensure that all children and young
people in London are able to access appropriate
mental health support when they need it.
• Schools and colleges will have the opportunity

to receive evidence-based training delivered by
the Anna Freud Centre through the Schools Link
Programme, so that children are able to receive
the help they need at an earlier stage. We will work
with CCGs and Local Authorities to ensure that all
education settings are aware of this programme
and encourage the highest possible engagement
• We will also establish a dedicated programme to

work with schools, children’s centres, early years
education providers and local integrated care
systems, with the aim of increasing participation

London Vision
Improve mental health
and progress towards
zero suicides
Our ambition: London is a city

where everyone’s mental health and
wellbeing us supported; working
The challenge
towards becoming a Zero Suicide city we face…
Our commitment: we will ensure Two million Londoners experience mental ill
health every year. The impact of mental illness in
that all Londoners have access not equal, with poverty and deprivation acting as
to mental health care, support key drivers of poor mental health. Austerity has
impacted financial and housing security and public
and treatment, especially those services; essential to protect from mental illness
experiencing health inequalities and for recovery
Up to
2 million 140 12
Londoners experience mental ill Londoners per 100,000 were Londoners die each week
health every year detained under the Mental from suicide
Health Act in 2017/18
Stigma and health inequalities,

That’s including the mortality gap of
13 10-20
The Mayor of London’s Health
Inequalities Strategy included
plans to tackle income inequality,
a significant factor in, and
people on the average
years,
consequence of, mental illness
bus and more than 100 remain a significant cause
on the average tube of concern
38
• Promoting open conversations about mental • Ensuring people living with severe mental
health and wellbeing through Thrive LDN’s ‘Are illness have a physical health check and that
you OK London?’ campaign action is taken based on the findings
• Promoting the London Healthy Workplace Award to • Increasing access to a range of alternatives to
encourage employers to promote and support traditional crisis care, such as Crisis Cafes
mental health and wellbeing
• Delivering a pan-London s136 model of care
• Innovating to develop Good Thinking, a digital with the NHS, police, local authorities and
mental health and wellbeing service for adults voluntary sector that supports people in crisis
• Offering small grants (through Team London) to • Developing local multi-agency suicide reduction
voluntary and community sector organisations plans, led by Public Health teams in Local
working to support people affected by loneliness and Authorities
social isolation through social prescribing
• Reducing suicide remains an NHS priority with
• Increasing access to psychological therapy close clear commitments to post suicide-support services
to home, and perinatal mental health care and reducing inpatient suicides
• Achieving waiting time targets for urgent • Encouraging all staff in the NHS, and in wider public
mental health services: 24/7 community-based services to undertake suicide prevention training
crisis response for adults and older adults, and
all-age mental health liaison service for all London’s
emergency departments
Our next steps…

• We will focus on interventions in schools, Information Hub to deploy system-wide
colleges, workplaces, and building social intelligence across London on suspected and
connectedness in communities for those in older completed suicides
age. For example, Thrive LDN is working with
Papyrus in schools and colleges to engage with, • The NHS, Local Authorities, and the
and support, the work of London’s Universities Metropolitan Police Service will help London’s
to improve student mental health employers by running internal campaigns to
encourage employees to complete Zero Suicide
• We will simplify access to support and services Alliance training and, where appropriate, more
through digital routes, such as Good Thinking, intensive training e.g. for NHS emergency
using digital tools that support efficient person- departments staff
centred decision making, digital communication/
information sharing with professionals and • We will promote social connectedness to prevent
between services and once people are in suicide in later life through social prescribing
services, they are offered digital enabled
therapies and tools to support their recovery
• We will build on our ambition to be a Zero

Suicide city, by changing social attitudes and
behaviour, and by deepening our understanding
on how and where to intervene
• The Mayor is leading a public-facing campaign

with Thrive LDN for 100,000 Londoners to
complete the free 20 minute Zero Suicide
Alliance training. Thrive LDN will continue
to develop an interagency real-time Suicide

London Vision
Improve
air quality
Our ambition: every Londoner

breathes safe air The challenge
Our commitment: we we face…
work together to reach legal
The quality of London’s air is dangerous to health
concentration limits of Nitrogen and breaches legal limits. Air pollution contributes
Dioxide (NO2) and working towards to thousands of premature deaths each
exacerbates poor health23,35,36
WHO limits for particulate matter2.5
concentrations by 2030.
2 million c.450
Schools were still in areas that Air pollution affects everyone
Londoners live in areas that exceed
exceeded legal limits for NO2 but children and older people
legal limits for air pollution
in 2016 are more at risk
400,000 Those living in deprived

communities are more likely to be
exposed to higher concentrations
Children’s developing and of pollutants than those in less
Children under 18 live in areas that growing lungs are at greater risk deprived communities
exceed legal limits for air pollution of developing asthma
40
• Delivering the London Environment Strategy and Emission Bus Zones, and over 2,200 zero emission
Mayor’s Transport Strategy commitments to capable taxis
improve air quality and ensure 80% of trips are
made by active or sustainable modes (walking, • Conducting air quality audits at 50 of the most
cycling and public transport) with all Londoners polluted primary schools and 20 nurseries and
achieving the 20 minutes of active travel each day working with schools and workplaces to reduce their
that they need to stay healthy by 2041 contribution to air pollution by switching to walking,
cycling and public transport
• Local authorities are implementing the TfL Healthy
Streets Approach, Public Health England (PHE) • Exploring opportunities for trip consolidation,
recommendations and National Institute of Health and including through telemedicine and integration of
Clinical Excellence (NICE) guidance on air pollution non-emergency patient transport services
• Supporting all Londoners to achieve 20 minutes • Promoting the text alerts system to advise
of active travel every day Londoners of pollution episodes and the
protective actions that those with heart and lung
• Launching the Ultra Low Emission Zone (ULEZ) disease should take during high pollution episodes
in central London, where vehicles driving
in the zone must meet new, tighter • All health and care partnerships to take a
emission standards or pay a daily charge networked, multi-disciplinary approach to
and introducing a number of Liveable and Low asthma care for all ages, including promoting the
Emission Neighbourhoods #AskAboutAsthma campaign
• Cleaning up the bus and taxi fleet, which now

includes over 200 electric buses, 12 twelve Low
Our next steps…

• London boroughs will deliver a major expansion emissions each year in London (based on 2015
in electric vehicle infrastructure by putting in place average fleet emissions). Reducing motor traffic
300 rapid charge points by 2020, and 20 in each volumes also has benefits in terms of reduced noise
borough by 2022 and an improved environment
• The Ultra Low Emission Zone boundary will be

expanded to the North and South Circular Roads
in 2021
• The NHS will cut business mileages and fleet air

pollutant emissions by 20% by 2023/24. At least
90% of the NHS fleet will use low-emissions engines
(including 25% Ultra Low Emissions) by 2028, and
primary heating from coal and oil fuel in NHS
sites will be fully phased out. Our plans to reduce
outpatient appointments in London by 30% have
the potential to avoid up to 50,000,000 miles of
journeys. We estimate, that this could lead to a
30,000 kg reduction in traffic-related NOx emissions
and a 2,500 kg reduction in traffic-related PM10

London Vision
Improve tobacco
control and
reduce smoking
Our ambition: for London to be a

smoke free city The challenge
Our commitment: we will we face…
speed up a reduction in smoking Smoking remains London’s leading cause of
prevalence in London, especially premature death, causing the early deaths of over
8,000 people per year. It contributes to four out of
among groups with the greatest the five most common health conditions that kill
health inequalities Londoners37,38,39
13.9% 8,000
The number of adults smoking Smoking remains London’s leading Inequalities remain stark, with people
has fallen from 20% in 2011 cause of premature death, killing working in manual occupations and/or
8,000 people per year living with serious mental illness, smoking
more than the general population
38.9% £12.6bn Investing £1 in tobacco control

of people living with a serious mental The annual financial cost of
health illness are smokers smoking to society intervention could save £2.07 by
year five, £3.92 by year 10 and
£11.38 over a lifetime
42
• Promoting the ‘Stamp IT Out London’ illegal • Sharing best practice from the Smoking in
tobacco campaign, which takes place each year Pregnancy challenge group, following the
learning event in October 2019
• Ensuring that the ‘Stop Smoking London
Programme’ is available to all Londoners • Offering tailored support from PHE to each
STP to understand the scale and costs of local
• Continuing to deliver better outcomes for patients tobacco-related harm, and the benefits of
through the Screening and brief advice for taking action.
tobacco and alcohol use in inpatient settings
Commissioning for Quality and Innovation scheme
Our next steps…

We will establish a London-wide partnership ‘Smoke • We will ensure a focus on addressing smoking
Free London’ with NHS, Local Authorities PHE, among key ‘at risk’ groups including people in
voluntary and community sector, GLA, London routine and manual occupations, pregnant women,
Councils and academia with the overall aim of further people with mental health needs including drug
reducing rates of smoking in the capital by: and alcohol users, and specific ethnic groups
• We will agree an accelerated reduction aspiration • We will adopt a rounded approach to addressing
for London tobacco, with work on tobacco linked into the alcohol
agenda including the development of Alcohol Care
• We will further develop the “Stop Smoking London” Teams highlighted in the Long Term Plan
programme as an asset for Londoners
• Undertake Pan London action to address

illegal tobacco
• We will support the availability of brief intervention

training, including Making Every Contact Count to
support a consistent approach across organisations
• We will encourage and support the rollout of the

Ottawa stop-smoking model to all NHS services,
focusing on smoking in pregnancy and smoking
cessation support for those in contact with mental
health services

London Vision
Reduce the
prevalence and
impact of violence
Our ambition: every Londoner feels

safe, knowing that we have reduced
violence in their community
The challenge
we face…
Our commitment: we will work
collaboratively with the London The number of violent incidents across England
and Wales has increased each year since 2014.
Violence Reduction Unit to develop Whilst London has observed a lower rate of
and implement effective ways increase than other areas, the number of violent
incidents in London is unacceptably high and is one
of reducing violence, including of the Mayor of London’s highest priorities56,57,58
addressing its root causes
200,000
offences of violence including 120 The Royal London Hospital on The VRU unites specialists from health,
homicides were recorded in London average admits two people a day with police, local government, probation
in the 12 months to March 2019 a stabbing injury, having a devastating and community organisations
effect on families and placing
avoidable pressure on NHS staff
28% 7%
of Londoners report feeling Violent incidents have increased by The areas of London most
that knife crime is a problem 7% in London and by 22% nationally affected by violence are often
in their local area in the 12 months to March 2019 those with high deprivation
44
Our commitments so far…
• Working at neighbourhood level and with local • Building on the Information Sharing to Tackle
Community Safety Partnerships we are continuing Violence (ISTV) programme, we are continuing
to develop best practice and multi-agency to work together to review opportunities to:
action plans that address violence in local identify individual and community risk and
areas, which can be evaluated and promoted by the preventative factors; build the evidence base,
Violence Reduction Unit (VRU) and to share data with the VRU and its partners
• Embedding case workers in Major Trauma Centres • Supporting the VRU to develop a movement
for example St. Giles Caseworkers who offer against violence that promotes positive messages
support to young people admitted to the Royal and activities for London citizens, building stronger
London Hospital as a result of serious violence and safer communities
Our next steps…

• NHS London will establish a clinical and • Working with the VRU and other agencies across
professional network that provides leadership London, we will develop new models of care for
across the health system and establish a Violence people affected by violence, which will be co-
Reduction Academy to support and equip local produced with the people they aim to support
health systems to develop and implement best-
practice evidence-based models across the capital • We will support the VRU’s work to strengthen
London’s network of support for those affected
• NHS London will explore a more integrated violence and trauma. This will include expanding
trauma model so Londoners affected by violence support to parents and families; investing in
and trauma can receive more effective, joined up London’s youth workers and developing trauma-
physical and psychological support awareness among frontline professionals
• Violence reduction will be factored into JSNAs and

into the work of Health and Wellbeing Boards
• Local health and care partnerships will interrogate

existing care pathways for opportunities to reduce
violence and social risk factors
• We, as a London-wide partnership, will identify

promising new or non-traditional models of
prevention and early intervention and look to
evaluate, share and scale good practice across
the capital
London Vision
Improve the
health of
homeless people
Our ambition: no rough sleepers die on

the street, no one is discharged from a
hospital to the street and there is equal
The challenge
and fair access to healthcare for those we face…
who are homeless.
The Homeless in London have some
of the worst health and shortest lives
Our commitment: we commit to drive of all adults. We need to address the
health issues that are both a cause
action to improve, grow and innovate and a consequence of being homeless,
services that improve the health of rough alongside often complex social needs.
We have to work collectively to design
sleepers, including expanding the pan- integrated services to improve health and
London rough sleeping services funded prolong life40,41,42,
by the Mayor, building on existing good

practice, piloting new models of care and
data collection, and developing plans to
build more integrated services in London
44 years
For every person sleeping rough,
there are estimated to be 13x more
‘hidden homeless’ who are sofa
Is the average age of death for The number of rough sleepers in surfing, living in cars or in other
those who are homeless London has more than doubled precarious circumstances
in the last 10 years
126 8,855
Different nationalities recorded People were seen sleeping rough People experiencing homelessness
amongst rough sleepers in London, in London in 2018/19 use hospital services 4x more than
with half born outside the UK general population
46
• Implementing a hospital homelessness and • Requesting that NICE produces comprehensive
immigration support service pilot, and a guidance to support homelessness prevention,
mental health pilot across four Mental Health integrated care and recovery
Trusts and 16 London boroughs
• Promoting guidance on care for homeless
• Improving access to mental health services, people at the end of their lives
through a specialist team to help coordinate and
carry out mental health assessments with people • Continuing to work with Safeguarding Adult Boards
sleeping rough to ensure robust Safeguarding Adult Reviews
are undertaken when a person sleeping rough
• Promoting training developed for GP dies and there is suspicion of abuse or neglect
receptionists and practice managers, and the
dissemination of Groundswell ‘my right to access • The Mayor is doubling City Hall’s rough sleeping
healthcare’ cards to promote GP registration budget in 2019/20 to around £18m
• Providing peer-led advocacy for rough sleepers

to access health services
• Supporting the implementation of existing homeless

health commissioning guidance for London, and
the development of Health & Wellbeing Boards
homelessness and rough sleeping strategies
Our next steps…

• We will develop a commissioning plan to establish • We will test ways of including housing status in data
integrated care pathways for rough sleepers; collections, quantifying the scale and progress in
including specific proposals to enable safe and improving homeless health
timely transfers from hospital to intermediate care,
step down accommodation, or assessment in a • We will deliver a focused London-wide
home if required homelessness partnership, providing leadership
and strategic oversight for London
• We will work with system-wide partners to support
rough sleepers to have better access to specialist
homelessness NHS mental health support,
integrated with existing outreach services,
sharing and promoting learning from pilots and
best practice
• We will identify key prevention and health

improvement opportunities, including health
screening and contacts with primary or urgent care,
and develop plans to promote these

London Vision
Improve services
and prevention for
HIV and other STIs
Our ambition: for London to

get to zero by 2030: no new The challenge
HIV infections, zero preventable
deaths and zero stigma
we face…
HIV is an important public health problem in
Our commitment: we will London. In 2017, an estimated 38,600 people were
living with HIV in London, representing 38% of all
broaden partnership working to people living with diagnosed or undiagnosed HIV
focus further on tackling health in the UK. Poor sexual and reproductive health,
including transmission rates of HIV have major
inequality and a wider range of impacts on population mortality, morbidity and
sexually transmitted diseases wider wellbeing43,59
1,549
Londoners were newly Black African people are over Despite considerable progress,
diagnosed with HIV in 2017 twice as likely to be diagnosed HIV is twice as common in
late with HIV London as it is in England
44% 14% 98%

of Londoners living with of HIV-diagnosed Londoners expressed of HIV-diagnosed residents were
diagnosed HIV were aged concern about discrimination in a receiving anti-retroviral treatment
between 35 and 49 years in 2017 health care setting in 2017 in London in 2017, exceeding the
UNAIDS target
48
• Continuing to build cross sector collaborations • Promoting prevention choices for Londoners
through London’s Fast Track Cities Initiative on a pan-London basis through the London
(FTCI) Leadership Group and providing oversight HIV Prevention Programme, funded by
London’s action on getting to zero London boroughs
• Continuing to engage the Department of Health and

Social Care in calling for access to PrEP for all to
be funded to reduce new HIV infections
• Deploying targeted health promotion, including

widening testing to reach those specific cohorts
of the population where new HIV infections
rates are highest and regular testing should
be encouraged
Our next steps…

• We will continue to be part of the FTCI, and to work
towards zero new HIV infections, zero preventable
deaths and zero stigma by 2030. We will invest £6m
into this initiative over three-years with particular
effort to support the 5% of people who live with
undiagnosed HIV
• London heath, care and government organisations

will achieve stigma-free status by 2022 and engage
other sectors towards the same aspiration
• We will reduce stigma by positively challenging myths

around transmission; promoting the message that
HIV is a long-term condition people live with and
through effective treatment cannot pass it on
• We will continue to deliver world class health

promotion across the city through the London HIV
Prevention Programme, funded by London boroughs
• We will use our learning from this HIV work to help

diagnose and treat other blood-borne viruses including
hepatitis C, and sexually transmitted infections
including chlamydia, gonorrhoea and syphilis

London Vision
Support Londoners
with dementia to
live well
Our ambition: London is the

world’s first dementia friendly
The challenge
capital city by 2022 we face…
Our commitment: we will ensure An estimated that 72,000 Londoners are living
with dementia, including around 3,700 people
that Londoners receive a timely living with young onset dementia (onset under
diagnosis, ongoing support and are 65). If current trends continue, there will be a 40%
increase in the people living with this condition by
able to live well in their community 2025. Diagnosis rates have significantly improved
over the last five years from 54% to 73%, however
there is significant variation across different parts
of London. 18,500 Londoners are still estimated to
be living with dementia without a diagnosis44,45,46,60
73%
£2.4bn Unpaid care accounts for 73% of the
total cost of people with dementia
is the total cost of dementia to Dementia diagnosis rates have
significantly improved across London living in the community, and 44%
the London economy per year
from 54% in 2014 to 73% in 2019 of the total cost of the overall
dementia population in London
6 weeks Two thirds 2x

An ambition has been agreed for services of London boroughs are doing some People with dementia stay in
to work towards 85% of people to receive kind of dementia friendly activity hospital twice a long as other
a diagnosis and initial care and treatment already older people
plan within 6 weeks of referral.
50
• Working with the Alzheimer’s Society to launch • Creating a cross sector executive board made
Dementia Friendly London and we are working up of senior leaders across the partnership. This has
towards: been established to oversee the Dementia Friendly
London strategy
• Establishing 2,000 dementia-friendly
organisations – including shops, GP practices • Establishing an, NHS London-led, mechanism of
and cultural venues including galleries and clinically led support to improve diagnosis rates
museums and sports venue – that have
considered people with dementia and taken • Improving integrated working in South West London
practical action is being completed; bringing psychiatrists,
neurologists and neuroradiologist together in a
• Recruiting 500,000 Dementia Friends across multi-disciplinary meeting
the public, private and community sectors –
including bus drivers and station staff, NHS staff • Agreeing with each STP, a mechanism to collect
and housing, and retail sectors memory service waiting time data and
Dementia Clinical Network to streamline pathway,
• Supporting all London boroughs to become completing a pan-London memory service audit
Dementia Friendly Communities building on
the work already underway
• Placing all people with dementia at the heart

of Dementia Friendly London through a People’s
Panel of Londoners living with dementia
Our next steps…

• Led by the dementia friendly London executive board,
sectors will establish local action plans to achieve
cross sector and individual ambitions
• The GLA will lead by example at City Hall where work

will be led by the Mayor’s Dementia Champion and
Chief Officer, Mary Harpley
• London Association of Directors of Adult Social

Services and Alzheimer’s Society are supporting
London’s boroughs to become dementia-friendly.
• NHS London will offer Dementia Friends sessions to

London regional staff
• NHS London’s expert Dementia Clinical Network will

bring together memory services and Parkinson’s clinics
to improve pathways and support joint working

London Vision
Improving care
and support at
the end of life
Our ambition: every Londoner is

able to die at home or in a place of
their choice, comfortably, surrounded The challenge
by people who care for them. we face…
Our commitment: we will ensure Londoners are disproportionately dying in
that all Londoners in their last year of hospital. The NHS Long Term Plan supports the
need to personalise care and to improve end of
life have access to personalised care life care. People entering their last year of life can
planning and support that enables be identified and offered personalised care and
support planning47
them to die in their preferred place
89% The overall cost of care is

understood to be lower outside
London also has the highest
average length of hospital
of people would prefer to die at of hospital settings stay for people with a terminal
home or in a hospice illness compared to other
regions in England
6% 15% The increase in the number of

those with long-term health
conditions means that people are
There is a considerably higher of all emergency hospital
more likely to require complex
proportion of hospital deaths in admissions in England belong
care for an extended period of
London, which is 6 percentage points to the 1% of people in their final
time before their death
higher than the national average year of life
52
• Developing a programme of work in all STPs focused • Developing and supporting CMC in all care settings
on improving the experience of End of Life Care in London including monitoring the quality of
(EOLC) records created
• Supporting health and care staff to identify people • Disseminating a resource developed by the
who are likely to be in their last year of life and EOLC Clinical Network to support primary
offer them personalised care and support planning care in achieving the new 2019/20 quality
improvement indicators of the Quality and
• Giving particular consideration to people likely to Outcomes Framework
have specific needs, for example those with learning
disabilities and people who are homeless
• Supporting the implementation of ‘Coordinate

my Care’ (CMC) for people in their last year of life,
ensuring that important information like wishes
and preferences is shared with services
providing urgent or unplanned care
Our next steps…

• NHS London will continue development and • Led by the EOLC Clinical Network; London’s
implementation of Coordinate My Care (CMC) hospices, community services and acute Trusts
through a lead commissioner approach, will come together with the aim to create a single
optimisation of digital enablers and wider clinical medication administration record chart
engagement education and training
• The Metropolitan Police, London Ambulance
• We will support adherence to the upcoming NICE Service, 111 services and the EOLC Clinical
guidance on EOLC service delivery across London Network will create a protocol for responding to
expected deaths in the community and associated
• The EOLC Clinical Network will complete a project training materials
with Newham CCG primary care using an electronic
identification search tool and clinical pathways to
improve EOLC identification and personalised care
and support planning. Learning from this will be
spread regionally

5 Our request of you: tell us what you think, and tell
us how you would like to be involved
This Vision document is the product of significant We hope you will join us as we move from ambition
stakeholder engagement and collaboration over the to action:
past year, including: through Thrive LDN and the
Fast Track Cities initiative; through advisory working
1. The London Health Board will host a health
groups with more than three hundred professionals
conference in October to engage leaders of
(from public health, social care and the NHS) and
statutory organisations in a conversation about
through local discussions on integration within each
our collective ambition and actions;
of the five Strategic Transformation Partnerships. In
addition we have attempted to recognise and reflect 2. Each partner organisation will use this Vision
the ambitions, policies and ideas set out within the as the common basis for discussion with sector
Mayor’s Health Inequalities Strategy, London Council’s stakeholders, using their respective range of
Pledges to Londoners, the Prevention Green Paper existing engagement channels and activities;
and the NHS Long Term Plan - each of which has itself
been the subject of widespread engagement. 3. We invite your specific reflections and
comments on any aspect of the Vision, which
can be sent to us at the following email address:
The Vision is an important collaborative document
[email protected]
to frame and support our ongoing conversation. We
have not attempted to cover every aspect of health
improvement in London or describe all actions that are
taking place locally. Instead we have focused on issues
where pan-London partnership action will add value
and accelerate improvement. The Vision is a guide for
us to design London wide and local action together.
54
6 Abbreviations
Acronym Definition
AKI Acute Kidney Injury
BHfL Better Health for London
CCG Clinical Commissioning Group
CMC Coordinate My Care
EOLC End of Life Care
FTCI Fast Track Cities Initiative
GLA Greater London Authority
GP General Practitioner
HCSN Health and Care Space Newham
HIV Human Immunodeficiency Virus
ICS Integrated Care System
LCP Local Care Partnership
LGA Local Government Association
LHCRE Local Health and Care Record Exemplar
LWNA Lambeth Living Well Network Alliance
MECC Making Every Contact Count
NHS National Health Service
NICE National Institute of Health and Clinical Excellence
PCN Primary Care Network
PHE Public Health England
STI Sexually Transmitted Infections
STP Sustainability and Transformation Partnership
UK United Kingdom
ULEZ Ultra Low Emission Zone
VCS Voluntary and Community Sector
VRU Violence Reduction Unit
WHO World Health Organisation

7 Glossary A-Z
Active travel
Active travel refers to transport that requires people to be physically active, such as walking and cycling. It also
includes scooting, skating and skateboarding. Public transport is usually included too as part of the journey will
have been done by active travel.
Acute Kidney Injury (AKI)

Acute kidney injury is a sudden episode of kidney failure or kidney damage that happens within a few hours or
a few days. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep
the right balance of fluid in your body.
Air quality
Air quality refers to whether levels of air pollutants are relatively high or low. It usually considers pollutants in
the UK Air Quality Standards Regulations 2010 (for example, particulate matter, lead, nitrogen dioxide).
Air pollution
Air pollution means substances in the air that harm human health, welfare, plant or animal life. Most pollution
in London is caused by road transport and domestic and commercial heating systems.
Better Health For London Report

The Mayor of London set up the London Health Commission in September 2013 to review the health of
the capital, from the provision of services to what Londoners themselves can do to help make London the
healthiest major global city.
Child obesity
Child obesity is a condition in which a child has a high amount of body fat. It is measured by comparing a
child’s Body Mass Index (BMI) with the population average, accounting for the child’s age, sex and height.
Clinical Commissioning Groups (CCG)

CCGs commission most of the hospital and community NHS services in the local areas for which they are
responsible. Commissioning involves deciding what services are needed for diverse local populations, and
ensuring that they are provided.
Co-ordinate My Care (CMC)

Coordinate My Care is an NHS clinical service that was launched in August 2010 to deliver integrated,
coordinated and high quality medical care, built around each patient’s personal wishes. The urgent care plan is
created jointly by the patient and their healthcare professional.
56
Commissioning for quality and innovation
The Commissioning for quality and innovation framework supports improvements in the quality of services
and the creation of new, improved patterns of care.
Cardiovascular disease
Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can
lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your
heart's muscle, valves or rhythm, also are considered forms of heart disease.
Disability
Disability is defined in the Equality Act 2010 as a physical or mental impairment that has a ‘substantial’ and
‘long-term’ negative effect on a person’s ability to do normal daily activities.
Early years settings

Places that provide childcare for the 0-5 age group, like childminders, crèches, nurseries, children’s centres,
nursery schools and schools with nurseries.
End of life care

End of life care involves treatment, care and support for people who are nearing the end of their life. It's an
important part of palliative care. It's for people who are thought to be in the last year of life, but this timeframe
can be difficult to predict.
Fast Track Cities Initiative

The Fast-Track Cities initiative is a global partnership between cities and municipalities around the world and
four core partners – the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations
Programme on HIV/AIDS (UNAIDS), the United Nations Human Settlements Programme (UN-Habitat), and
the City of Paris. Launched on World AIDS Day 2014, the network has grown to include more than 300 cities
and municipalities that are committed to attain the UNAIDS 90-90-90 targets by 2020: 90% of all people living
with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained
antiretroviral therapy (ART); and 90% of all HIV-diagnosed people receiving sustained ART will achieve viral
suppression. Achieving zero stigma is the initiative’s fourth target.

G
Good Work Standard

This is the Mayor’s vision for a new agreement with London’s employers to promote fair pay and excellent
working conditions. It also covers diversity and inclusion, good work-life balance, health and wellbeing,
professional development and lifelong learning, and employee voice and representation at work.
Green spaces
These are areas of vegetated land, like parks, gardens, cemeteries, allotments and sports fields, which may or
may not be publicly accessible. Together these spaces help to form London’s green infrastructure network.
Healthy Schools London (HSL)

This is the Mayor’s awards scheme to support and recognise school achievements in student health and
wellbeing. HSL promotes four themes: healthy eating, physical activity, emotional health & wellbeing and
Personal Social Health Education.
Health and Wellbeing Boards

These were established in 2013 to bring together local health commissioning groups, elected councillors
and senior council officers, with the purpose of designing local strategies for improving health and wellbeing
through closer working between health and local government.
Healthy life expectancy

This is an estimate of the number of years lived in “Very good” or “Good” general health, based on how
individuals perceive their general health.
HIV (human immunodeficiency virus)

HIV is a virus that damages the cells in the immune system and weakens the body’s ability to fight everyday
infections and disease.
Human papillomavirus (HPV)

This is a viral infection that's passed between people through skin-to-skin contact. There are over 100 varieties of
HPV, more than 40 of which are passed through sexual contact and can affect your genitals, mouth, or throat.
Illegal tobacco
Tobacco that is smuggled, bootlegged or counterfeit, sold cheaply and tax-free and often linked to large-scale
organised crime.
Improving Access to Psychological Therapies

A programme which began in 2008 to improve access for people with anxiety and depression, including OCD,
to evidenced based psychological therapies, such as Cognitive Behavioural Therapy (CBT).
58
L
Lead commissioner
A lead (or coordinating) commissioner arrangement is where commissioning functions are delegated by
organisations, within a partnership, to a specific organisation that carries out the commissioning functions.
London’s Child Obesity Taskforce

The Taskforce's vision is that every child in London grows up in a community and an environment that
supports their health and weight. Its purpose is to bring about a transformation in London so that every child
has every chance to grow up eating healthily, drinking plenty of water and being physically active.
London Health Board

This is a non-statutory partnership. It is chaired by the Mayor of London, and involves representatives of London’s
boroughs, NHS Trusts and Clinical Commissioning Groups, as well as Public Health England and NHS England.
London Plan
This is the Mayor’s spatial development strategy for London.
Mental ill health

This covers a very wide spectrum of mental health issues. It includes the worries and grief we all experience in
everyday life to suicidal depression or complete loss of touch with daily reality.
National Institute for Health and Care Excellence

The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of
the Department of Health in the United Kingdom, which publishes guidelines in four areas:
• the use of health technologies within the National Health Service (NHS) (such as the use of new and existing
medicines, treatments and procedures)
• clinical practice (guidance on the appropriate treatment and care of people with specific diseases
and conditions)
• guidance for public sector workers on health promotion and ill-health avoidance
• guidance for social care services and users

O
Older people
This refers to people over 50. It also recognises that those above retirement age and those over 70 may have
special requirements to address.
Overweight
This refers to people with a Body Mass Index (weight in relation to height) which is higher than is
considered healthy.
Primary care
Primary care provides the first point of contact in the NHS, and includes general practice (GP), community
pharmacies, dental, and optometry (eye health) services.
Primary Care Network

Primary Care Networks (PCNs) are a key part of the NHS Long Term Plan, with all general practices being
required to be in a network by June 2019, and Clinical Commissioning Groups (CCGs) being required to commit
recurrent funding to develop and maintain them.
PrEP
PrEP stands for pre-exposure prophylaxis. It is a drug taken by HIV-negative people before sex that reduces the risk
of getting HIV. In England it is available as part of a trial.
Prevention
In the context of a health inequalities strategy, it’s the work done to stop people from getting ill. Prevention
can be more cost effective and better for reducing health inequalities than treating ill health.
Public Health England (PHE)

Public Health England is an executive agency of the Department of Health and Social Care in the United Kingdom
that began operating on 1 April 2013. It works to protect and improve the nation’s health and wellbeing, and reduce
health inequalities.
60
S
Substance misuse
This is where a drug or alcohol is used in a way that harms an individual’s physical or mental health. Some people
will need specialist/medical support to help with recovery.
Sexually Transmitted Infections (STI)

An STI is an infection passed from one person to another person through sexual contact. An infection is when
a bacteria, virus, or parasite enters and grows in or on your body. STIs are also called sexually transmitted
diseases, or STDs. Some STIs can be cured and some STIs cannot be cured
Sustainability and Transformation Partnership (STP)

In 2016 the NHS and local councils came together in 44 areas covering all of England to develop proposals to
improve health and care. They formed new partnerships – known as sustainability and transformation partnerships
(STPs) – to run services in a more coordinated way, to agree system-wide priorities, and to plan collectively how to
improve residents’ day-to-day health.
Ultra Low Emission Zone (ULEZ)

The Ultra Low Emission Zone (ULEZ) replaced the T-Charge on 8 April 2019. It operates 24 hours a day, 7 days a
week, every day of the year, within the same area as the Congestion Charge zone.
Wellbeing
Wellbeing is a state of being where everyone can realise their potential, cope with the normal stresses of life, work
productively and fruitfully and contribute to their community.
World Health Organization (WHO)

The WHO aims to create a better, healthier future for people all over the world. It has offices in over 150
countries. WHO staff work with governments and other partners to ensure the highest attainable level of
health for everyone.
Zero-suicide city
This is an idea developed in the USA. It is founded on the belief that suicide deaths can be prevented. Zero
suicide relies on a system-wide approach rather than on the heroic efforts of individual practitioners. It
requires engaging the wider community, especially suicide attempt survivors, family members, policymakers,
and researchers.

8 References
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66

Our Vision: For London

Uploaded by

Our Vision: For London

Uploaded by

Our Vision

Foreword: Our Shared Vision 4

1 Our shared ambition is to make London the healthiest global city 5

3.1.1 Supporting joint working and integration in neighbourhoods 16

3.1.2 Supporting joint working and integration in boroughs 17

3.1.3 Supporting joint working and integration within sub-regional systems 18

3.1.4 Supporting joint working and integration through citywide partnership 20

OUR VISION FOR LONDON 3

OUR VISION FOR LONDON 5

Tobacco 1 1 Tobacco -15.7%

Dietary risks 2 2 High body-mass index (obesity) 8.8%

High blood pressure 3 3 Dietary risks -7.8%

Alcohol use 6 6 Alcohol use 0.8%

High LDL (cholesterol) 7 7 Occupational risks 3.8%

Occupational risks 8 8 High LDL (cholesterol) -18.5%

Air pollution 9 9 Drug use 5.8%

Drug use 10 10 Air pollution -9.5%

Metabolic risks Environmental / occupational risks Behavioural risks

Funding pressures faced by local government are

OUR VISION FOR LONDON 7

Our partnership is • London was the first region nationally to offer

Persistent challenges in delivering

Smoking prevalence in London adults has

The mortality among adults with

Extended 8am-8pm GP access is available

There is a 10% gap in mortality following

The proportion of Londoners who

OUR VISION FOR LONDON 9

Support us to work in our communities to engage people at risk of

Inform us about existing initiatives and help us to learn from others

Adopt a more holistic and positive approach to mental health,

Start well Live well Age well

OUR VISION FOR LONDON 11

Schools and health and care

Our environments and local Londoner's have access to high

Ensuring Londoners Digitally connecting

OUR VISION FOR LONDON 13

Over 120 research

Areas of focus for pan-London collaboration

1. Reduce childhood obesity 6. Reduce the prevalence and impact of violence

4. Improve air quality 9. Support Londoners with dementia to live well

• 203 Primary Care

• Joint working across NHS

OUR VISION FOR LONDON 15

collective ambition is • Voluntary budget pooling between a council and

partnerships to join up • Oversight of a pooled budget and a joint-

OUR VISION FOR LONDON 17

Clinically-led Whole System Pathways; Digital Innovation; Continuous Improvement

Mental Primary Community

Clinical Support Corporate Support

Pathology Pharmacy Imaging Payroll Bank & Agency IT

Endoscopy Other Private Patients Analytics Recruitment Other Corporate

Provider system able to be commissioned and funded on a population health basis

OUR VISION FOR LONDON 19

Through the London Health Board, elected leaders,

Important and innovative work is happening across

Area of focus The outcomes we think we should track

Reduce childhood • Reception: Prevalence of overweight including obesity

OUR VISION FOR LONDON 21

Improve tobacco • Smoking prevalence

Reduce the prevalence • Violent crime (including sexual violence)

Improve the health of • Number of people sleeping rough on the street

Improve services and • HIV testing coverage

Support Londoners • Dementia: Recorded prevalence (aged 65 years and over)

We will continue to explore whether there are other

OUR VISION FOR LONDON 23

Decent, affordable homes are a key determinant

clinical workforce by an where people come together to meet, to work, and to

OUR VISION FOR LONDON 25

OUR VISION FOR LONDON 27

• We will continue to build on previous engagement

OUR VISION FOR LONDON 29

OUR VISION FOR LONDON 31

Reduce Improve the emotional wellbeing of

Improve mental health and Improve

Improve tobacco control Reduce the prevalence