Tom Coffey | Senior Health Adviser to the Mayor of London, UK
Citation: EMJ Innov. 2026; https://doi.org/10.33590/emjinnov/NGGX7988
At this year’s Global Innovation and New Technology (GIANT) Health event, you spoke in the panel ‘A Brighter Future for Joined-Up London’. Often, London, UK, is described as fragmented. What, in your view, is the single biggest barrier to integrating services across the capital?
We’re hugely proud of London’s health and care service and the incredible people who make it what it is. Our capital has always helped to innovate and drive forward improvements in care, and it’s important that this pace increases and is shared widely so that patients benefit sooner and more equitably.
As a city of nine million people, we are faced with great complexity. Our health and care systems respond to a huge diversity of needs, and while there is no one-size-fits-all solution, integration is important and requires long-term commitment, stable funding, and strong partnerships.
One of the biggest barriers to integrating services has been the previous government’s chronic under-investment and increased bureaucratic rules that hindered innovation. This has made it far harder to build a consistent, joined-up system across the capital. The encouraging news is that we now have a national government committed to giving the NHS the support it needs to build a health system fit for the future.
During the COVID-19 pandemic, we also saw the importance of communities actively shaping health services, as it leads to increases in trust and improves outcomes. That’s why shifting more care into communities, a core part of the NHS 10-year plan, is so important. This will support neighbourhood-based care, as well as enable prevention and early intervention, and embodies the three key shifts from hospital to community, from sickness to prevention, and from analogue to digital.
During the panel, you noted that digital access has been particularly effective in sexual health. What lessons from sexual health digital pathways could be applied to other areas of care?
Digital sexual health pathways have shown how offering simple, confidential, and convenient access can dramatically increase engagement, particularly among people who might otherwise delay or avoid care. A key lesson is the importance of designing services around the user. For example, using digital triage to get people to the right support quickly, while maintaining clear routes into face-to-face care when it’s needed. These pathways also demonstrate how intelligent use of data can support prevention, early intervention, and better population health management. Applied more widely, this model can help other services become more accessible, proactive, and responsive to people’s real lives, while freeing up clinical time for those with the greatest needs. Sexual Health London also demonstrates what can be achieved at scale when a wide range of partners come together to collaborate on a digital pathway for a whole city’s population, rather than trying to achieve piecemeal solutions.
The NHS 10-year plan emphasises the digital shift, the neighbourhood shift, and a shift towards preventive medicine. Which of these three shifts do you believe London is most ready for today, and which is lagging behind?
London is particularly well placed when it comes to the shift to prevention, and this is an area where we are genuinely leading. As a general practitioner, I know that health outcomes are shaped as much by what happens outside the surgery as inside it. Housing, air quality, employment, education, and access to green space all have an impact on Londoners’ health. That’s why the mayor has put these issues at the heart of his agenda, taking a clear ‘health in all policies’ approach to making London a fairer, healthier, and more prosperous city for all.
For example, the expansion of the Ultra Low Emission Zone has helped reduce toxic air pollution; the free school meals policy is ensuring that all state primary schoolchildren are offered a free healthy lunch every day; the Healthy Schools and Healthy Early Years programmes are tackling health inequalities early by promoting good nutrition, oral health, physical activity, and cognitive development; and changes to advertising on the Transport for London (TfL) network have reduced Londoners’ exposure to junk-food marketing. These interventions don’t just improve health; they help reduce long-term pressure on the NHS.
London is also making strong progress on the shift from acute to community care. I’m especially proud of the pioneering work led by London Health and Care Partners to develop a London-wide operating model for neighbourhood health services. Published in May 2025, this was shaped through extensive collaboration over nearly a year between City Hall, boroughs, NHS organisations, public health, social care, the voluntary sector, and Londoners themselves.
The digital shift is where the opportunity is greatest. OneLondon has been working for several years to join up information to support efficient, effective, and safe care across the capital. The London Care Record is already saving health and care professionals’ time, up to a value of 4.6 million GBP each month. And there are excellent frontline examples, from ambient voice technology that frees up clinicians’ time, to smart data tools like CVDACTION (UCLPartners, London, UK) supporting cardiovascular prevention at scale, and digital interventions for insomnia such as Sleepio (Big Health, San Francisco, California, USA) and SleepStation (Newcastle upon Tyne, UK) that are reducing waiting lists, medication use, anxiety symptoms, and even work absence. London has incredible innovation capability, but the challenge now is accelerating adoption, spreading what works, and ensuring that digital solutions reduce health inequalities.
How does political alignment between the mayor and government open new opportunities for improving health and care in London?
Our relationship with the government creates a real opportunity to move faster and go further. We now have a national government committed to supporting the NHS in building a health system fit for the future, and in London that allows the mayor and our partners to focus on addressing the health inequalities that persist across the capital. Sadiq Khan’s priorities are set out in his Health Inequalities Strategy Implementation Plan, which is centred on giving every child the best start in life, valuing mental health equally with physical health, ensuring that everyone has a safe home, and tackling structural racism and inequality.
From the NHS in London and the Office for Health Improvement and Disparities, to London Councils, Directors of Public Health, businesses, communities, and the voluntary sector, alignment strengthens collaboration across the system. We know that by working together, we can improve the conditions that shape health long before people ever need care. That is how we empower Londoners to take control of their health and live longer, fuller lives.
What is the one thing you hope clinicians take away from your session about the future of joined-up, neighbourhood-based care?
I hope clinicians leave with a clear sense that neighbourhood health services are about making care work better for patients and staff. By shifting care closer to home, integrating services around people’s lives, and addressing the social factors that shape health, we can reduce hospital admissions, improve access, and provide more support for those most at risk. This model recognises that health is not just about medicine, but about housing, isolation, employment, and community, and it brings together multidisciplinary teams to holistically respond to those realities.
Most importantly, I want clinicians to know that they are not being asked to do this alone. In a city as large, diverse, and complex as London, partnership is essential. Joined-up, neighbourhood-based care depends on collaboration across health, social care, local boroughs, and the voluntary sector, and clinicians are at the heart of making that vision real for Londoners.
