Centering excellence? : national and regional health services in London

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This paper concentrates on London's role as the principal national centre for specialist health services. The capital retains this function because of its concentration of undergraduate and postgraduate teaching hospitals. However, the shift of population away from the city's centre over the past century has created problems of access which remain pertinent today. The paper makes a detailed examination of changes in the pattern of specialist services since the London Health Planning Consortium recommended rationalisation and dispersion from the city centre in the early 1980s. In practice, it concludes that a further expansion and concentration of most specialist services has taken place in inner London between 1980 and 1990. However, the paper argues that the changes brought about by the NHS and Community Care Act 1990 may result in changes to traditional care patterns. It was prepared to inform the work of the King's Fund Commission on the Future of Acute Services in London. It is being published in advance of the Commission's Strategy for London in order to inform debate about the future of health care in the capital, but should not be interpreted as anticipating the recommendations of the Commission's final report.

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