Assessment of North West London’s proposed elective orthopaedic care centre against all six of the Mayor’s Tests

As part of a role in collaborating with the NHS and other health partners on behalf of all Londoners, the Mayor of London developed six tests to apply to all major health and care transformation and reconfiguration programmes, designed to help to challenge the NHS to demonstrate that major changes are in the best interests of all Londoners. The Nuffield Trust has been supporting the development and evolution of these tests, and undertook a review of the Mayor of London's health inequalities test which resulted in their being updated in November 2022.   

As a potential major update to the healthcare system in the capital, North-West London’s proposed elective orthopaedic care centre is eligible for assessment under this framework. In January 2023, The Nuffield Trust assessed the proposals against the first four of the Mayor’s ‘six tests’ for major service reconfigurations. That analysis was used by the Mayor to inform his response, which was broadly positive but sought some changes and clarifications, particularly with respect to healthcare inequalities and staffing.

In March, following the publication of the Consultation Report4 and the availability of the London Clinical Senate’s review of the proposals, we completed tests five and six. On March 15 the final pre-publication version of the Decision-Making Business Case (DMBC) was made available to the GLA and Nuffield Trust in order to review changes made since the PCBC and in light of the Mayor’s earlier response, as well as the public consultation and input from the Clinical Senate.

This final report from the Nuffield Trust supplements the original report on the first four tests with tests five and six and adds further commentary (in red) indicating where NWL NHS has changed its plans since the PCBC or has otherwise responded to issues raised during the consultation period.