"Better Health for London" is usually summarised as a single ambition: making the capital the healthiest major city in the world. That framing is accurate but incomplete. Behind it, the 2014 London Health Commission report, chaired by Professor Lord Ara Darzi, set out more than 60 individual recommendations organised around ten stated aspirations, several with specific numbers and dates attached. Reading the report’s actual proposals, rather than just its headline ambition, is the clearest way to understand what it was really asking London to do.
The Ten Aspirations That Structured the Report
Everything in the report was organised beneath ten aspirations for London. They ranged from the earliest years of life to the city’s role in digital health, and together they set the frame every specific recommendation sat inside:
- Give all London’s children a healthy, happy start to life.
- Get London fitter, with better food, more exercise, and healthier living.
- Make work a healthy place to be in London.
- Help Londoners kick unhealthy habits.
- Care for the most mentally ill in London so they live longer, healthier lives.
- Enable Londoners to do more to look after themselves.
- Ensure every Londoner can see a GP when they need to, at a time that suits them.
- Create the best health and care services of any world city, throughout London and on every day.
- Fully engage and involve Londoners in the future health of their city.
- Put London at the centre of the global revolution in digital health.
Some of these read as broad statements of intent. Others, especially around primary care and prevention, were backed by proposals specific enough to be checked against, years later, for whether they actually happened.
Prevention: Where the Report Put Numbers on Its Ambitions
The prevention chapter is where "Better Health for London" moved furthest from generic aspiration into named, checkable proposals. On childhood obesity, it set a target of a 10% reduction in the proportion of children obese by year six, and aimed to reverse the trend in overweight children by 2020. To support that, it proposed preventing new fast-food outlets from opening within 400 metres of schools, and compulsory traffic-light nutrition labelling in restaurant and cafe chains with more than 15 national outlets. On smoking, it recommended a ban across London’s parks and other public spaces owned by local and regional government. On physical activity, one of the more distinctive proposals was dedicating part of Transport for London’s advertising budget to encouraging Londoners to walk 10,000 steps a day. Underneath all of this sat an aspiration to make every London child school-ready by age five by 2020 — treating early years development as a public health outcome, not just an education one.
Primary Care: The Report’s Biggest Single Financial Commitment
Nowhere in the report was the ask more concrete than on GP access. It proposed offering GP practices roughly £1 billion over five years, both to improve premises and to enable practices to open 12 hours a day, from 8am to 8pm, delivered across local practice networks rather than by every single surgery independently. Where GP provision was persistently poor, it recommended offering "capitation premiums" — additional funding per registered patient — to attract new providers, including from the private sector, into those areas. It also proposed that GPs work in formal networks to widen the range of services on offer and give patients more convenient appointment times, alongside allowing patients to move more freely between networks. Two commitments came with hard dates: by the end of June 2014, everyone aged 75 and over was meant to have a named GP responsible for coordinating their overall care, and from April 2014 changes were meant to begin allowing patient records to be shared securely between general practice and other services, with consent.
Mental Health: New Standards for Crisis Care
The report treated mental health as core to its brief rather than a separate track, with an explicit aspiration to reduce the gap in life expectancy and health experience faced by people with severe mental illness. Its most concrete output here was a new set of London Mental Health Crisis Commissioning Standards, which set out what care Londoners in mental health crisis should be able to expect: access to a 24-hour telephone helpline, dedicated areas for mental health assessment plus 24-hour liaison psychiatry cover in Accident and Emergency departments, and 24-hour clinical support available to police dealing with a mental health incident. The report also called for a pan-London, multi-agency model of care for both adults and children in crisis, and for youth mental health support that made better use of technology, alongside earlier access to psychological therapies within primary care itself.
Governance: Who the Report Expected to Deliver It
A report of this size is only as useful as its follow-through mechanism, and the Commission was explicit on this point. The Mayor of London committed to personally chairing a group tasked with preparing a unified delivery plan, and to continuing to chair a refocused London Health Board with oversight of how the aspirations were actually being delivered. That board was also expected to keep health inequalities in view as wider conversations about devolving health and care decision-making to London progressed — a governance thread that runs through much of what has followed in London health policy in the years since.
Recommendation Areas at a Glance
| Area | Example proposal | Stated target or mechanism |
|---|---|---|
| Prevention | Childhood obesity reduction | 10% reduction by year six; reversed overweight trend by 2020 |
| Primary care | Extended GP opening hours | Roughly £1bn over 5 years; 8am-8pm via practice networks |
| Primary care | Named GP for older adults | All patients 75+ by end of June 2014 |
| Mental health | Crisis care standards | 24-hour helpline; liaison psychiatry in A&E |
| Governance | London Health Board | Mayor-chaired oversight of delivery |
Taken together, these recommendations show a report that was as much an implementation plan as a diagnosis. Some proposals, like the named-GP commitment, had a hard date attached from the outset; others, like the 400-metre fast-food buffer around schools, depended on local authorities choosing to act on planning powers the report could only recommend they use. That gap between what "Better Health for London" asked for and what individual boroughs and providers were actually able to deliver is a large part of why this review exists: to track, plainly and without spin, which of the report’s specific recommendations actually became practice in London.