The clock is ticking, and in less a month the NHS will start emerging from the biggest top down reorganisation it has ever faced. London's healthcare economy, and the quality of service for patients, will suffer. So far the Mayor has washed his hands of responsibility to safeguard the health and healthcare services of London. This cannot continue. The time has come for him to step up to the plate and stand up for Londoners.
Death knell for Primary Care Trusts
If Strategic Health Authorities and Primary Care Trusts were supposed to be bureaucratic, centrist behemoths unable to respond to the needs of patients in an ever changing health economy, get set for chaos to rule supreme come 1 April when they go offline.
A confusing concoction of organisations will take their place, each with a different role and not one of them with oversight in their remit. There is a huge risk of escalating fragmentation in which patients will suffer, costs will escalate and an NHS that will be poorer in every sense of the word as a result.
This complex web of organisations is a recipe for uncoordinated chaos.
Dismantling of NHS
In December last year Boris spoke out against the reorganisation of the NHS in London, telling the London Assembly that he was concerned about the removal of integrated planning. He said: "I do not want to see NHS London dismantled in the way that it has been".
But for his public concern there has been virtually no action.
London Health Improvement Board
Initially, in conjunction with London Councils, the Mayor established the London Health Improvement Board to put together a London wide plan for public health issues such as obesity, cancer and alcohol addiction, funded by pooling a small percentage of the money Boroughs would get from the Government for these new duties.
These plans came to a screeching halt at the end of 2012 when the Government reneged on its previous promise to give the LHIB the power it needed to operate. His failure to lobby his own government for the power to do the right thing for Public Health in London leaves the capital without the coordination it desperately needs.
Health Inequalities in London
Whilst the Mayor may not be in the business of running healthcare services, he does have a responsibility to combat health inequalities. There couldn't be a bigger health inequality than some communities having access to great quality services, whilst others are forced to suffer the burden of travelling tens of miles to access services that they should be able to get locally.
Beyond Mayor's remit
But not having powers has never stopped Boris before. He has no responsibility for aviation, taxation or education, but that has not prevented him spending millions of pounds in public money appointing advisers on aviation for his ill-fated Boris Island, lobbying the government on slashing the top rate of tax for the highest earners, or setting up an entire team to help open free schools in the police and fire stations he intends to close.
Care Quality Commission's report
In January, the Mayor faced strong questioning over the Care Quality Commission's latest report. It revealed an NHS under intense pressure and reaching crisis point. A&E waiting times are getting longer and more patients have to wait in ambulances outside because there is no room in the A&E Department to receive them (the longest wait recorded so far in England is 5 hours and 42 minutes, in London 2 hours 34 minutes). This brings flooding back the bad memories of the NHS in the 1990s under the last Conservative Government, with patients being left on trolleys in corridors due to lack of beds.
Cuts to London Ambulance Service
The unprecedented mix of increasing NHS cuts and mass re-organisation that is being enforced by the Coalition Government will only add to the rising pressure. The London Ambulance Service has to save £53 million by 2016 and has already announced 890 job losses, 560 of which will be from the front line. This will take place before the impact of the eight A&E Departments due for closure across London is known. These cuts are too far, too fast and are putting Londoner's lives at risk.
Despite all of this, Boris is happy to sit silently on the fence. He was repeatedly asked to intervene to stop the downgrading of Lewisham A&E, which is opposed by local clinicians with a united voice and is a Trust performing well. Likewise, Ealing Hospital is also under threat but the local community, local GPs, consultants, nurses and health professionals are opposed to it. The Mayor says he cares about clinical opinion, but he acts only if that opinion backs his government's policy.
In the future fragmented landscape of healthcare in London, we will desperately need someone to take the lead in ensuring that Londoners get the healthcare services they need. At the moment we're stuck with a Mayor more concerned with his next job than the one he's currently doing. It is ordinary Londoners who will suffer.
Follow Dr Onkar Sahota on Twitter: www.twitter.com/dronkarsahota