Introduction

The 2010 election of the Coalition government ushered in a new era of economic austerity underpinned by a set of political ideologies designed, in large part, to justify it. In a now-(in)famous poster used as part of the Conservative Party campaign in the run-up to the General Election, David Cameron is pictured, delicately airbrushed, alongside the words ‘We can't go on like this. I’ll cut the deficit, not the NHS’. Soon after, the newly formed Coalition government announced that the NHS would have to find efficiency savings of L20 billion by 2014-15. This cut would be accompanied by a dramatic institutional recalibration of the organisation of the health service, with newly formed general practitioner (GP) consortia directly commissioning services, the dissolution of primary care trusts (PCTs) and their incorporation within local authorities as well as the establishment of a new agency, Public Health England (DH, 2010a, 2011). These changes have been accompanied by a powerful rhetoric of the importance of the local, expounded most powerfully in the Localism Act (2011) which makes provision for changes to housing, planning and council responsibilities. At the root of these governance shifts lies the belief that ‘for too long, central government has hoarded and concentrated power’ through, for example, targets, inspections and unnecessary bureaucracy (DCLG, 2011, p 3). Instead, the Localism Bill argues, power should be devolved to local government, democratically elected mayors and local communities. Together, these governance changes herald a new landscape of health provision, funding and political ideology in England, raising inescapable questions about the sustainability and future of the ‘healthy’ city at a time of austerity. As Barton and Grant (2008, p 131) argue, ‘human wellbeing, now and in the future, is the “touchstone” of sustainability’, and it is this contention and its significance for London that is the focus of this chapter.

Since 2010, very few areas of public service provision have been left untouched by austerity measures. Education, housing and social care are just a few of the domains undergoing high-profile organisational, ideological and economic restructuring, while simultaneously having their budgets cut by up to 40 per cent (DH, 2010a; DCLG, 2011).