- The National Health Service in London faces profound challenges. Currently, services are under intense strain. Access to appropriate care for Londoners is jeopardised, and public confidence has declined. In inner London, in particular, there are high levels of deprivation and growing health inequalities. While some of the country's leading hospitals are based in central London, general practice is patchy, 'intermediate' care remains underdeveloped and there is a crisis in mental health services. In 1993 the Government set out to change health services in London. There has been real progress in establishing four main groupings for the future development of specialist medical services, teaching and research. But much remains to be done. Success depends on integrating care to meet individual and community needs. It is necessary now to continue the process of transformation, while safeguarding standards of care in the interim, and re-establishing public confidence. Substantial changes to the organisation and delivery of care are required to achieve this. Critically, this must include the creation of local alliances working within a new policy framework. Future policy must concentrate not only on the Health Service, but also on tackling poverty and unemployment and on the regeneration of the capital.