This piece of writing could be a lot better. Yes you have numbers, congratulations; and yes two departments have been downgraded. Why not look into why London's departments are so busy, the amount of non-appropriate visits made to A&E by Londoners, the lack of availiability of GP's and the low budget that the NHS has to cope with in London. It's an incredibly busy city, unlike any other. It just seemed that you were solely blaming the hospitals and their respective boroughs.

This is a huge issue, one that is only going to get worse (increasing population, reducing budgets etc) reporting, and bring it to peoples attention is great, just try to piece together the bigger picture before commenting.

Thanks Jen. If you're interested in the reasons, we've written articles in the past about A&E - have a look at http://londonist.com/2013/1... or http://londonist.com/2013/0... for examples. The King's Fund has also done an excellent myth busting articles on whether or not we're using A&E more (we're actually not using 'type 1' A&E that much more http://www.kingsfund.org.uk... )

We are discussing here of 4 hours time target that even at 100% is miserable. A decent level should be 80% in 30 mins. 85% in 45 mins. and 95% in an hour just to be similar to other worlds capital. Every visit to a doctor is appropriate - I would like just to remind You the Hippocratic Oath. We can discuss over it for decades but two millennia of culture can't be wiped out by a poor managed system. And much more is not about money, is about the lack of the vision that we have this issue. A&E is the core of any public services, more then school and army, because involve the preservation of life in every form, not only the appropriate one, that is most supreme value of our civilization - and for this reason without any doubt must be performed in an excellent way. Just to look to the real bigger picture before commenting.

Shouldn't it be pointed out that photo is of uclh, the hospital which is meeting the A&E target, not north west London trust

North West London Trust has messed up badly. They allowed Hammersmith and Central Middlesex A&Es to close before they opened their new £20 million A&E at Northwick Park. This is simply bad management on their part. It was meant to open "in the autumn" and still hasn't.

The largest factor in NHS finances is the £20 billion a year Nicholson Challenge kicked off by Labour's Andy Burnham in 2009. The NHS North West London "Shaping a Healthier Future" programme (SaHF) is just the local roll out of Nicholson as is made clear in the introduction of their consultation document. Beyond the financial driver SaHF simply implements the ideas of Labour's Darzi Review. The Labour party's denounciation of this scheme has been one of the most nakedly hypocritical campaigns ever run in London.

Just to make sure Labour had cover to proceed with Nicholson, it was put in the 2010 Labour manifesto on page 4:3.

Labour has no plans to undo Nicholson and will have to preside over the £22 billion of further savings signaled by by Nicholson's successor Simon Stevens.