Health & Healthcare in London
Key Facts
January 2009
Overview of London’s Health
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The geography of London
London’s population and diversity
Health determinants
Key lifestyle issues
Health inequalities
Key health issues
Health care use
LONDON’S GEOGRAPHY
London Boroughs and Acute Trusts
Enfield
31
2
3
Barnet
Harrow
Haringey
Waltham
Forest
7
Redbridge
11
30
27
Islington
Hackney
Camden
Hillingdon
4
Havering
19
1
22
Brent
24
28 23
Ealing
15
Newham
20
21
CityTower Hamlets
Westminster
13
K&C
25
Southwark
6
Hounslow
Barking &
Dagenham
H&F
8
9
29
Greenwich
18
26
Lambeth
Richmond
Lewisham
17
5
12
Merton
16
Kingston
K & C - Kensington and Chelsea
H & F - Hammersmith and Fulham
Bexley
14
Wandsworth
Bromley
32
10
Sutton
Croydon
1 - Royal Free Hampstead
2 - Royal National Orthopaedic Hospital
3 - North Middlesex University Hospital
4 - The Hillingdon Hospital
5 - Kingston Hospital
6 - Ealing Hospital
7 - Barking, Havering And Redbridge Hospitals
8 - West Middlesex University
9 - Queen Elizabeth Hospital
10 - Bromley Hospitals
11 - Whipps Cross University Hospital
12 - Queen Mary's Sidcup
13 - Guy's And St Thomas'
14 - The Lewisham Hospital
15 - Imperial College
16 - Mayday Healthcare
17 - St George's Healthcare
18 - King's College Hospital
19 - The Whittington Hospital
20 - Newham Healthcare
21 - Barts And The London
22 - Tavistock And Portman
23 - Great Ormond Street Hospital
24 - Moorfields Eye Hospital
25 - The Royal Marsden
26 - Chelsea And Westminster Healthcare
27 - Homerton University Hospital
28 - University College London Hosp
29 - Royal Brompton And Harefield
30 - North West London Hospitals
31 - Barnet And Chase Farm Hospitals
32 - Epsom And St Helier University Hospitals
© Crown Copyright. All rights reserved.
[LHO 100042264, 2006]
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There are 32 Main Acute Trusts in London
There are 31 Primary Care Trusts coterminous with 33 London Boroughs
LONDON’S POPULATION AND DIVERSITY
Key Facts
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7.55 million resident population in Greater London (ONS 2007)
Highly ethnically diverse with 42% from an ethnic minority group (including
White Irish and Other White minority groups) (ONS 2006)
More than 90 different ethnic groups and 300 different languages spoken
Largest religious groups are Christian, Muslim, Hindu, Jewish, Sikh and
Buddhist (2001 Census)
Home to many refugees and asylum seekers
Highly mobile (20-40% turnover on GP lists every year)
1.1 million daily commuters (CAPC 2006)
15.6 million visits were made to London by overseas residents in 2006 (Travel
Trends 2006)
LONDON’S POPULATION AND DIVERSITY
Population Age Structure
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London is relatively young with 15
- 44 years olds accounting for
49.5% of the population compared
to England average of 41.6%.
(ONS 2007)
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The proportion of people of
retirement age is the lowest of all
regions (13.8 %) as wealthier
people tend to move out of the
Capital at retirement age. (ONS
2007)
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Black and minority ethnic
populations are relatively younger
but are fast growing and ageing.
There are large variations in the
demographic structure of different
ethnic groups.
Source: ONS population estimates 2007
Number of people .
LONDON’S POPULATION AND DIVERSITY
Population Growth
2200000
2000000
1800000
1600000
1400000
1200000
1000000
800000
600000
400000
200000
0
00-04
'05-14
15-29
30-44
45-64
65-74
75+
2001
2008
2031
Year
Source: GLA PLP LOW projection 2008
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London’s population increased by 228,000 (3.1%) between 2001 and 2008
London’s population is expected to increase by 9.46 thousand (12.5%) by
2031
The 45-64 age group will increase by more than 463,000 (29%) by 2031
LONDON’S POPULATION AND DIVERSITY
Number of people in each minority ethnic group, London 2006
ONS Ethnic Estimates 2006 (excluding White British)
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Almost 3.2 million Londoners
are from an ethnic minority
group (42% of the population).
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39% of the England & Wales
population from an ethnic
minority group live in London.
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The largest minority ethnic
group is White Other followed
by Indian, Black African and
Black Caribbean.
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The Black African group has
more than doubled in the last
ten years, and the number of
Bangladeshis has increased
by nearly three quarters since
1991.
Chinese or Other Ethnic Group: Other
LONDON
Chinese or Other Ethnic Group: Chinese
ENGLAND
Black or Black British: Other Black
Black or Black British: Black African
Black or Black British: Black Caribbean
Asian or Asian British: Other Asian
Asian or Asian British: Bangladeshi
Asian or Asian British: Pakistani
Asian or Asian British: Indian
Mixed: Other Mixed
Mixed: White and Asian
Mixed: White and Black African
Mixed: White and Black Caribbean
White: Other White
White: Irish
0.0
500.0
1,000.0
1,500.0
2,000.0
LONDON’S POPULATION AND DIVERSITY
HEALTH DETERMINANTS
Health Determinants in London compared to England average
This slide extracted from the Health Profile 2008 shows how London is doing in terms of the
main socio-economic influences on health. Red is significantly worse than England, Green
significantly better
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Deprivation, including long term unemployment, is a lot higher than average.
Over 33.9% of London’s children are living in poverty, much greater than
average.
GCSE achievement is close to the England average
Violent crime is high.
HEALTH DETERMINANTS
Inequalities in Health Determinants in London
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Within London there are wide inequalities in living conditions, and other socioeconomic factors that have an influence on health. These inequalities exist between
people living in different parts of London, between different ethnic groups, age groups
and other groups.
Over half of London boroughs are in the top 30% most deprived boroughs in
England, and 24% of boroughs are in the top 10% most deprived, with nearly all
boroughs having pockets of deprivation.
Newham, Tower Hamlets and Hackney have some of the highest unemployment
rates in the country, whereas other boroughs have rates well below average.
The Bangladeshi population has the highest unemployment rate, and the White
British the lowest.
Educational (GCSE) attainment is highest in Chinese children and lowest in Black
Caribbean children.
People from a minority ethnic group are more likely to live in an unfit home than the
White population.
HEALTH DETERMINANTS
KEY LIFESTYLE ISSUES
Lifestyle influences on health in London compared to England
average
This slide extracted from the Health Profile 2008 shows how London is doing in terms of the main
lifestyle factors influencing health. Red is significantly worse than England, Green significantly better.
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More people eat healthy food in London than England
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Fewer people binge drink in London than England
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There are fewer obese adults, but London has higher rates of childhood obesity
than the rest of England.
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Smoking levels are slightly below the national average.
KEY LIFESTYLE ISSUES
Obesity – key facts for London
In London every year, obesity accounts for
• 4,000 deaths (7% of all deaths) :
– 300 deaths and 2,700 hospital admissions for cancers
– 450 deaths and 1,300 hospital admissions for stroke or raised blood
pressure
– 600 deaths and 2,500 hospital admissions for angina or heart attack
– 250 deaths and 2,400 hospital admissions for diabetes
– 1,300 hospital admissions for osteoarthritis or gout
• Adult obesity is related to social class, and is higher among more deprived
populations, particularly for women.
• London has higher rates of childhood obesity than the rest of England.
Source ‘Choosing health. A briefing on nutrition, physical activity and obesity in London’ LHO Feb 2005
KEY LIFESTYLE ISSUES
Smoking in London
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Smoking is a major cause of cancer, respiratory disease, circulatory and
ischemic heart disease.
In London, smoking causes:
– more than 10,000 deaths each year (1 death/hour)
– 200 deaths per week among people aged 35 and over in London are attributable
to smoking
– 46,000 hospital admissions and more than 400,000 bed days a year
Smoking costs the NHS in London >£105 million a year.
Least affluent populations are most likely to smoke.
Highest smoking prevalence is amongst Bangladeshi, Turkish and Irish
men.
Over a million Londoners are affected by smoking in the workplace
There are marked social inequalities in smoking rates between the most
affluent (who smoke least) and the least affluent who are most likely to
smoke.
Source ‘Choosing health. A briefing on tobacco in London’ LHO 17 Feb 2005
KEY LIFESTYLE ISSUES
Standardised rate of deaths attributable to smoking in London by
Borough, 2004-2006
Source APHO Health Profiles 2008
KEY LIFESTYLE ISSUES
Alcohol in London
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On average Londoners drink less often and fewer drink above sensible levels
compared to the England average.
People on high incomes and the unemployed are most likely to drink above sensible
levels and to binge drink.
People from many ethnic minority groups are more likely to be non-drinkers.
More Londoners are dependent alcohol users compared to England.
The death rate due to alcohol in London is slightly lower than nationally. (Table7.7
Focus on London 2008)
Alcohol misuse impacts on health care at all levels.
Alcohol consumption contributes significantly to the volume of injuries in London.
Main source ‘Choosing health. A briefing on reducing alcohol-related harm and encouraging sensible
drinking in London’ LHO Apr 2006
HEALTH INEQUALITIES
Life expectancy and causes of death
This slide extracted from the Health Profile 2008 shows how London is doing in terms of the
major killers. Red is significantly worse than England, Green significantly better.
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–
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Road injury rates, life expectancy and early cancer are better than the England average
Infant mortality and deaths from smoking are similar to the England average in London.
More people die prematurely from heart disease and stroke than the England average.
However, these figures mask wide inequalities between London’s Primary Care Trusts.
HEALTH INEQUALITIES
The life expectancy PSA target
The PSA target for life expectancy aims to see faster health improvement
compared to the average in the “fifth of areas with the worst health and
deprivation indicators” – The Spearhead PCTs/LAs. The Spearhead LAs are indicated on
this map.
HEALTH INEQUALITIES
Life expectancy in London, 2004-06
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Male
Female
England
77.3
81.6
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London
77.4
82.0
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London
Spearhead
group
75.6
80.8
Source: ONS
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For males in 2004-2006, life
expectancy in England was 77.3.
This is very similar to the average
for London, but 2.3% higher than
in the London Spearhead Group.
For females, life expectancy in
England was 81.6, 1% higher than
in the London Spearhead Group.
These gaps have to be reduced
by 10% for the life expectancy
target to be achieved.
London as a whole is on track to
reach this target, but not all
spearhead areas are on track.
Differences in Life Expectancy within a small area in London
Travelling east from Westminster, each tube stop represents nearly
one year of life expectancy lost –Data revised to 2002-06
Male Life
Expectancy
78.6 (CI 76.0-81.2)
Canning Town
Female Life Expectancy
84.6 (CI 82.5-86.7)
Male Life
Expectancy
72.8 (CI 71.1-74.6)
Female Life
Expectancy
81.4 (CI 79.3-83.6)
Westminster
London Bridge
River Thames
Canada
Bermondsey Water
Canary
Wharf
North
Greenwich
Waterloo
Southwark
Has this been updated? Yes
London Underground
1
Jubilee Line
Electoral wards just a few miles apart geographically have life
expectancy spans varying by years. For instance, there
are eight stops between Westminster and Canning Town
on the Jubilee Line – so as one travels east, each stop, on
average, marks nearly a year of shortened lifespan. 1
Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health
HEALTH INEQUALITIES
Infant mortality rates (deaths < 1 year),2004-2006
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The infant mortality PSA target aims for a reduction in the gap in mortality rate among those with
fathers in the “routine and manual” groups and the population as a whole.
This target is difficult to measure at local levels due to the small number of deaths involved.
Within London as a whole the infant mortality rate is falling.
There is a more than three fold differential in the infant mortality rates for different London
boroughs. This differential can be measured as a proxy for the PSA target.
SPECIFIC HEALTH ISSUES IN LONDON
Key Facts
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London has highest number of new diagnoses of sexually transmitted infections (STI) out of all
regions. (29% of all English new diagnoses in 2007)(HPA)
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The London average teenage pregnancy rate was higher than the England average in 2006 (and
very much higher in Inner London). (ONS and Teenage Pregnancy Unit 2008)
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In 2007 London accounted for 48.3% of HIV cases in contact with services in the UK. (HPA)
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On the basis of measures of need such as MINI and NPMS London has significantly higher
demand for mental health services than England, and specifically for people with severe Mental
Health problems. (APHO Indications: Mental Health Section 2.2)
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London has the highest tuberculosis (TB) rate out of all regions and the number of case reports
per 100,000 population rose from 36.5 per 100,000 population in 2000 to 44.8 per 100,000 in
2006. (HPA 2008)
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Many diseases such as tuberculosis, diabetes, HIV, renal disease and coronary heart disease are
more common in specific ethnic groups who are more commonly resident in London. (APHO
Indications: Ethnicity and Health)
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5.2% of 16-59 year olds reporting having used Class A drugs in the last year in London compared
to 3.4% in England & Wales (Fig 4.10 2005/06 British Crime Survey)
SPECIFIC HEALTH ISSUES - SEXUAL HEALTH
Number of newly diagnosed STI’s reported from genitourinary (GU)
clinics in London 1999 - 2007
25,000
20,000
gonorrhea
15,000
Chlamydia
herpes first attack
10,000
warts first attack
5,000
Source: HPA
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
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Chlamydia diagnoses have more than doubled since 1998 and are highest in the young.
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New syphilis episodes sharply increased in London between 2003 and 2007(33.0%). (HPA)
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The presence of STIs can facilitate HIV transmission.
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The percentage of people offered an appointment to be seen at a GUM clinic within 48 hours in
London has increased steadily from an average of 68.9% in 2005 to 97.9% in 2008 (Sexual
Health Indicators Report, LHO)
SPECIFIC HEALTH ISSUES - SEXUAL HEALTH
HIV - a growing burden in London
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London accounted for 48.3% of cases in contact with care in the UK in 2007.
(HPA)
In 2007 – 3175 new infections were diagnosed in London. (HPA)
In 2008 – an estimated 27% of HIV infections may be undiagnosed. (HPA website)
Nearly all new heterosexual HIV infections have been among Black Africans –
three quarters acquired in Africa. (See New Diagnoses National Overview HPA
website)
Men who have sex with men are the largest group to have acquired infection in
London. They represent about 50% of cumulative new diagnoses of HIV in
London since 1992 or earlier. (UK HIV New Diagnoses June 2008 Table 4)
Heterosexual transmission is largest group of current new diagnoses nationally
but the number of new diagnoses of this type in the UK appears to have peaked .
(UK HIV New Diagnoses June 2008 Table 5)
4.0% of injecting drug users in 2006 contacting specialist services in London
have HIV infection (0.7% Rest of England). (Unlinked Anonymous Survey of
Injecting Drug Users: data to the end of 2006 HPA)
SPECIFIC HEALTH ISSUES – SEXUAL HEALTH
Teenage Pregnancy 2006
Under 18 Conception Rate 2006
90.0
80.0
London
England
70.0
60.0
50.0
40.0
30.0
20.0
10.0
Kingston upon Thames LB
Harrow LB
Richmond upon Thames LB
Barnet LB
Redbridge LB
Bromley LB
Sutton LB
Ealing LB
Bexley LB
Havering LB
Brent LB
Merton LB
Hillingdon LB
Hounslow LB
Waltham Forest LB
Enfield LB
Croydon LB
Greenwich LB
Barking and Dagenham LB
Kensington and Chelsea LB
Westminster City of LB
Camden LB
Hammersmith and Fulham LB
Tower Hamlets LB
Newham LB
Islington LB
Hackney LB & City of London
Wandsworth LB
Haringey LB
Lewisham LB
Southwark LB
Lambeth LB
0.0
Source: TPU, DfES, 2006
• Teenage Pregnancies (TP) include all conceptions to women aged <18 years of age.
• In 2006 the London TP rate was 45.6/1000 females aged 15-17 compared with 40.6/1000 nationally
with the highest number of TP occurring in deprived areas.
• Rates fell between 1998 and 2006 in 28 boroughs but there were large increases in 5 boroughs.
SPECIFIC HEALTH ISSUES – MENTAL HEALTH
Mental Health
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In London an estimated 14.8% of adults had a GHQ12 score of 4 or more indicating a possible
psychiatric disorder in 2004. England’s value was 13.2%. (APHO indications of mental health)
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Current trends suggest London is on track to meet London’s PSA target rate of 7.2 suicides per
100,000 by 2009-11(LHO using NCHOD data to 2005-07)
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Mental health problems are more prevalent in deprived areas (Many studies show this relation)
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London has a significantly higher demand for mental health services than England, and
specifically for people with severe mental health problems.
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According to ‘Mental Health in London’ Briefing LHO Nov 2005 London has:
– Higher admission rates
– Higher proportion of inpatients with severe mental illness
– Higher occupancy rate despite more beds
– Higher use of forensic beds
– Highest rate of compulsory admissions
– Highest spend on mental health services
– Higher crude caseload rates in some community services
– Large populations at risk of mental health problems e.g. asylum seekers
SPECIFIC HEALTH ISSUES – TUBERCULOSIS (TB)
London sector TB rate per 100,000 resident population
50
45
40
35
30
London
25
England
20
15
10
5
0
2000
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2001
2002
2003
2004
2005
2006
London tuberculosis (TB) rate per 100,000 population rose from 36.5/100,000 in 2000 to 44.8/100,000 in
2006. (Source: HPA London Regional Unit, 2006)
Nationally 66% of newly diagnosed cases in 2006 were among foreign born populations. (HPA)
The highest number of new cases occurs among the Asian and Black African populations. (HPA
Enhanced Tuberculosis Surveillance 2007)
smr 2004-2006
140
london
120
england
100
80
60
40
Standardised Mortality Ratio
SPECIFIC HEALTH ISSUES – ETHNICITY
Mortality from diabetes by London Borough 2004-06
180
160
20
0
Westminster, City of LB
Kensington and Chelsea LB
Havering LB
Bexley LB
Sutton LB
Bromley LB
Camden LB
Hammersmith and Fulham LB
Kingston upon Thames LB
Richmond upon Thames LB
Harrow LB
Redbridge LB
Barnet LB
Enfield LB
Southwark LB
Wandsworth LB
Barking and Dagenham LB
Greenwich LB
Croydon LB
Ealing LB
Merton LB
Hillingdon LB
Islington LB
Lewisham LB
Brent LB
Waltham Forest LB
Hounslow LB
Lambeth LB
Tower Hamlets LB
Newham LB
Haringey LB
Hackney LB
Source: Compendium of Clinical Indicators
There are wide inequalities in mortality from diabetes. Boroughs with large
populations from ethnic minority groups such as Hackney, Haringey, Tower Hamlets
and Newham have the highest rates.
HEALTH CARE USE
Age standardised admission rates by PCT, fin06/07
Kensingt on and Chelsea
Richmond upon Thames
Hounslow
West minst er
Havering
Croydon
Camden
Harrow
Kingst on upon Thames
Barnet
Bromley
Redbridge
M ert on
Bexley
Sut t on
Brent
Wandswort h
Hillingdon
Hammersmit h and Fulham
Sout hwark
Ealing
Barking and Dagenham
Islingt on
Lambet h
Enf ield
Haringey
Tower Hamlet s
Walt ham Forest
Lewisham
Cit y & Hackney
Greenwich
Newham
0
5000
10000
15000
20000
25000
Directly age standardised admission rate per 100000
Source: Hospital episode statistics and LHO
30000
HEALTH CARE USE
Healthcare Commission Inpatient Survey 2004
Londoners are less satisfied with the NHS; BME patients are particularly
dissatisfied NB risks of Patient Choice.
Source: Healthcare Commission Patient Survey
SUMMARY OF LONDON’S KEY HEALTH
CHALLENGES
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Ethnically diverse population with high mobility and population growth
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London as a whole has slightly below average mortality rates and slightly higher life
expectancy than England as a whole, but has above average rates of premature mortality
from circulatory disease, and wide inequalities between boroughs/PCTs
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Key lifestyle issues such as obesity, smoking and alcohol are contributing to poor health in
London’s more deprived areas
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London has high rates of teenage pregnancy and sexually transmitted infections such as
HIV
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The incidence of tuberculosis is rising and is more common among ethnic minority groups
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London has significantly higher than average demand for mental health services,
particularly for people with severe mental illness.
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Primary care services are performing relatively poorly. (Darzi report on London)
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Londoners are more dissatisfied with the NHS, especially those from BME groups.
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