Council asks Jeremy Hunt to intervene after borough becomes first in London to axe IVF

Tags

, , ,

Jeremy Hunt is under pressure to block Croydon’s decision to become the first London borough to axe IVF funding in a radical bid to save NHS cash.

The Health Secretary has been asked by Croydon council to intervene after the borough’s clinical commissioning group voted to withdraw funding for fertility treatment with immediate effect last month.

The council says the decision has created a “postcode lottery” for infertile Londoners and could discourage young people from moving to the borough.

More than three-quarters of respondents to the CCG’s consultation wanted IVF to be retained. The decision – which breaches NHS guidelines on the availability of fertility treatment – forces infertile couples in Croydon into spending thousands on private treatment if they want to have children.

The council says the decision unfairly impacts on those unable to afford private healthcare and could lead to an increase in anxiety, depression and relationship breakdown.

It comes as a Richmond CCG consultation on restricting IVF to “patients with exceptional clinical circumstances” closed this week. A final decision is expected next month or in July.

Croydon IVF

Evening Standard story from March 2017 on the original decision

The Croydon decision, which will save about £1.1 million over two years, is also likely to result in the closure of the fertility unit at Croydon hospital, which has treated thousands of women. The CCG has been ordered to make £54 million of cuts.

Councillor Carole Bonner, chairwoman of the council’s health scrutiny committee, said: “We’re making this referral because of the potential long-term adverse health effects the removal of IVF will have on Croydon residents.  

“Not only can infertility result in family breakdown and the ending of relationships, but it often has an impact on the mental health of those affected.

“A comprehensive study was carried out by Middlesex University and the Fertility Network that showed a clear correlation between infertility and depression, with 90 per cent experiencing depression.

“The committee is acutely aware of, and has sympathy for, the CCG’s underfunding and the inconsistencies of the funding formula when compared to similar authorities. However, we feel that the effects of the withdrawal of IVF funding in Croydon are not in the best interests of the borough’s residents.”

Council leader Tony Newman said: “It’s true to say that the decision to withdraw funding will be reviewed in a year, but, even if the funding is restored at that point, there would be residents who have passed the age limit and missed the chance of conceiving.   

“On a personal level, that could have devastating consequences, and that’s why we’re urging the Secretary of State to review the CCG’s decision and also to allocate additional funding to the historically underfunded Croydon group.”

The Department of Health said that all CCGs had been advised to implement the NHS guidelines – for three full cycles of IVF – in full. A spokeswoman said: “Fertility problems can have a serious and lasting impact on those affected, which is why we expect all CCGs to implement NICE guidelines.”

Croydon CCG previously funded one round of IVF or ICSI – a more precise form of treatment that involves injecting sperm directly into an egg – to women under 39 who had been unable to conceive for three years. An average of 94 couples a year received free treatment.

Dr Agnelo Fernandes, assistant clinical chair of Croydon CCG, said: “We took this difficult decision only after careful consideration and discussion in the context of the increasingly challenging financial position we face. We have a statutory requirement to prioritise front line services for the people of Croydon and live within the financial resources available to us.

“We will work closely with the committee and the Department of Health to ensure the process is dealt with as swiftly as possible to bring certainty to Croydon residents.  
“We would like to stress that IVF and ICSI are still available to those with exceptional clinical circumstances and that other forms of fertility treatment are still available.”

Revealed: how hospitals became the best in London at meeting A&E targets

Tags

, ,

A hospital boss today told a radical rethink of emergency care led to its A&Es becoming the quickest in London at treating patients.

Epsom and St Helier NHS trust pioneered new systems to get patients home as soon as possible after running out of beds during the 2015/16 winter.

The results, which surprised even its own staff, saw it deliver the seventh best A&E performance in the country in January and achieve the NHS target of treating 95 per cent of patients within four hours for the entire 2016/17 year.

Its approach could provide a solution to the growing NHS crisis in preventing patients who are also dependent on social care from getting stuck in hospital.

It could also offer a lifeline to a trust struggling with buildings at St Helier that date to 1937, and which is at risk of losing out in a proposed shake-up of A&Es in south-west London.

Daniel Elkeles at St Helier hospital

Chief executive Daniel Elkeles (above) said: “About this time last winter, we ran out of space. We decided to completely rethink the emergency care pathway. There was no more space at either Epsom or St Helier to admit people.

“It was either build some more capacity – for which there was no money – or this. Everybody knows that there are patients in the hospital for whom it is no longer appropriate for them to still be here.”

Under the patient flow transformation programme, hospital leaders meet at 9am, 11am and 3pm to assess the status of every inpatient in their care.

Mr Elkeles said: “The objective is: what do we need to do for this patient today so that we can get them home? You end up with an agreed action list for each of these patients.

“In 20 minutes we go through the entire hospital, knowing who is definitely going home today, and who could be going home today if we did X, Y and Z. [The key thing] is that we have all the people who can make X, Y and Z happen in the room.

“If you join up everything we are doing, we have as good an emergency care pathway as you can provide in the UK.”

By improving patient flow, the trust has freed-up beds – meaning it has not had to cancel an operation since last October for urgent care or cancer patients.

In addition, it is saving up to £2 million a year by no longer having to send patients waiting too long for surgery to private hospitals.

At St Helier, a 22-bed “step closer to home” ward has been established for patients who are medically ready to leave but who cannot quickly return home, often due to a lack of carers or because they require neuro-rehabilitation.

At Epsom, an “at home” service sees medics and council social services teams assess patients together and provide full support for their first 72 hours back home. Dr Guan Lim, clinical director for medicine at Epsom, said: “It’s a real game-changer in how we provide this care.”

The entire trust is said to have “bought into” the four-hour A&E target, rather than just seeing it as the emergency department’s concern. An ambulatory care centre aims to treat and discharge patients referred from GPs within a day.

Amir Hassan, lead emergency consultant, said the key to coping with new patients was ensuring the swift treatment and discharge of existing patients.

“Everyone says we are understaffed and under-resourced,” he said. “The reason why we are under-staffed and under-resourced is because we are dealing with too many patients sitting in A&E without being moved on.”

Dr Simon Winn, clinical lead of the acute medical unit, said: “If they don’t need to be in hospital, we should be doing everything we can to facilitate them to leave.”

Prince William meets hospital staff and paramedics who responded first to the Westminster terror attack

Tags

,

William at St Thomas's

Prince William heard how staff from St Thomas’s hospital ran to help victims of the Westminster terror attack when he thanked them for their efforts.

Among the medics the Duke of Cambridge met at the hospital were Dr Gareth Lloyd, a junior doctor who helped the wounded on Westminster bridge after seeing the incident as he made his way to work, and Dr Colleen Anderson, a junior docutor who went to help after seeing the atrocity from the hospital.

Other who met the prince on his visit to the hospital yesterday were A&E consultant Dr Holly Gettings, ward sister Margaret Kallon and Charlotte Wilce, a senior physiotherapist who also attended patients on the bridgee after witnessing the attack from the hospital.

Pictured with William, from left, are: Dr Gettings, Ms Kallon, Rob Nichols (acting head of nursing, inpatient services), Carl McIntosh (security operations manager), Ms Wilce, Dr Lloyd, Dr Anderson, Jess Child (resilience manager).

William at LAS

Earlier in the day William visited London Ambulance Service, which sent 68 staff to the incident and took 23 patients to hospital.

Motorcycle paramedic Richard Webb-Stevens, who was the first ambulance responder on scene said: “Initially, I thought I was going to a road traffic collision and my first priority was to assess and triage the patients and report back to our control room.

“I started at one end of the bridge and worked my way across, checking all of the patients, some of whom were very badly injured. The public were amazingly helpful and comforted the injured while help was on the way and doctors and nurses ran out to help from the local hospital.

“I was very focused on treating patients and it wasn’t until much later that I found out it was a terrorist attack. We train our whole lives for incidents like this and you hope it will never happen, but I consider it a privilege to do this job and play a small part in helping patients.”

Emergency medical dispatcher Clare Miles, who took one of the first 999 calls, said: “There was so much noise in the background but the caller said he thought he’d just witnessed an attack and a car had crashed into lots of people. Seconds later I took a call about a woman who was in the Thames.

“I could see that lots of calls were coming into the control room so I knew we were dealing with something serious. I was covered in goose bumps the whole time, but we train for incidents like this and we have to be able to stay calm and level-headed and be there for the person on the phone.”

London parents to be offered digital version of ‘Red Book’ that charts child development

Tags

,

An online version of the “red book” given to parents to monitor they first years of their child’s health and development is to be rolled out across London.

The e-Redbook will be available for the 136,000 children born each year in the capital, providing digital back-up for parents who lose the paper version.

The initiative was announced today as part of the widespread changes to the way the NHS operates. These will see patients wait longer than the current 18-week target for non-urgent surgery to enable more money to be spent on GPs, A&E and cancer.

The digital version of the red book – officially known as the personal child development record – was trialled in Newham, Greenwich, Kingston, Inner North West London and Barnet. NHS England said the traditional version, on which health workers chart a child’s weight, height and vaccination records, would not be scrapped.

Parents will be able to access their child’s records on a smartphone and iPad app. The system alerts parents to forthcoming appointments and immunisations – increasing uptake and reducing the cost of missed appointments. Pregnant women can access the app from 28 weeks’ gestation to allow them to become familiar with the developmental milestones.

Meanwhile, NHS England London today said that six new Linac radiotherapy machines to deliver precision cancer treatment would be provided across the capital.

One is already in place at UCLH, with Barking, Havering and Redbridge, North Middlesex, Imperial College Healthcare – which gets two for Charing Cross hospital – and the Royal Marsden due to receive theirs over the next 18 months.

In addition, rapid diagnostic centres for cancer will be opened in the coming year at UCLH, Queen’s, North Middlesex, Royal Free and the Royal Marsden.

See here for a new low in the relationship between Imperial and Hammersmith and Fulham council in relation to Charing Cross hospital.

Air ambulance doctor and paramedic reveal role in 999 response to Westminster terror attack

Tags

, ,

An air ambulance doctor today praised the bravery of the medics and civilians who rushed to help the victims of the Westminster terror attack.

Dr Tony Joy, of London’s Air Ambulance, was first on the scene with a fellow doctor and advanced paramedic when the charity helicopter landed in Parliament Square.

Dr Tony Joy

Junior doctors and nurses ran from St Thomas’s hospital to tend to the injured and dying on Westminster bridge while junior doctors’ leader Jeeves Wijesuriya helped treat the attacker New Palace Yard.

Dr Joy, 35, a consultant at the Royal London hospital, told the Standard: “I was aware that there were a number of people who had come to help. Absolute respect to all the clinicians and all the passers-by that were involved. Some people would have done that completely instinctively.

“They would have wanted to help and they would not have known how much of a risk they were putting themselves in. That to me takes real bravery and should be profoundly commended.”

He told told how he and his LAA colleagues prepared for a “mass casualty event” as they prepared to land. A total of 68 London Ambulance paramedics and emergency staff were also involved.

“We understood we were going to a road traffic collision with about 20 patients,” Dr Joy told Sky News. “That obviously focuses the mind. We prepared for a mass casualty event and thought about what that might entail.

“As we were overhead we could see that it was a complicated clinical scene over some distance over the bridge. We tried to gather some information but there wasn’t much clinical information at that time. We were there very early.

“When we arrived on the scene, our job is to provide clinical care to the most critically injured patients but also with incidents like this to support London Ambulance Service in setting up the strategic control of a very complicated major incident.”

The charity, which needs about £4 million a year to keep its two helicopters flying, has been inundated with more than £10,000 in donations overnight as people pay tribute to its work.
To donate £5, text SAVE to 70800.

Dr Joy said it was a “pretty awful day”  but a “privilege” to have been able to help people at their greatest time of need. “We prepare for it but we don’t expect it to happen,” he said. “It certainly focuses the mind.

“Our patients are very vulnerable. They didn’t expect it but they are having their worst-ever day. It is humbling to be involved in helping on the worst day of their lives.”

Ambulance chiefs today paid tribute to frontline staff for “an exceptionally good job” as they treated the victims.

LAS medical director Fenella Wrigley told the Standard: “Yesterday was something we always hoped would never happen, but which we were prepared for. We were able to provide specialist teams trained to respond to this type of incident.

“The staff did an exceptionally god job. They were calm and provided very good clinical care. I remain very proud and grateful to our staff for all they did under extremely difficult circumstances.”

Jon Goldie, a LAS paramedic manager who co-ordinated the response on the scene, said: “There were a variety of injuries. We quickly looked to establish where all the patients are who is the sickest and who needs immediate transfer to hospital.”

Malcolm Alexander, chairman of the LAS Patients Forum, said: “The London Ambulance Service was on the scene fast and LAS staff carried out their difficult tasks in an atmosphere of fear and uncertainty, providing Londoners and those visitors injured in the attack support and assistance.

“We wish to praise and acknowledge the hard work and dedication of London Ambulance Service on this most difficult of days and salute their dedication and service.”

Cycle tsar urged to block plans for ‘rumble strips’ on Hyde Park bike lane

Tags

, ,

London’s new cycling commissioner was today under pressure to halt plans to install cobble-stone speed humps in Hyde Park after a cyclist was clocked at 32mph.

Campaigners called on Will Norman, appointed by Mayor Sadiq Khan, and deputy mayor for transport Val Shawcross to force the Royal Parks to reconsider the £215,000 installation of 28 rows of raised granite setts next week on a key route between Speakers Corner and Hyde Park Corner. The route is part of the Central London Cycle Grid and is used by more  than 1,200 cyclists an hour in the morning.

Parks bosses decided to act after a survey last June recorded one cyclist riding at 32mph around 7pm on the Broad Walk, which is split 50-50 between a cycle path and pedestrian walkway. The Royal Parks wants cyclists to ride at a “considerate cycling speed” of 8-12mph though this is not legally enforceable.

The installation of similar cobbled “rumble strips” on Mount Walk in Kensington Gardens last year backfired – cyclists divert round them onto the grass or speed up to minimise the discomfort of riding over them.

The survey found about two-thirds of cyclists rode at what would be regarded as a typical commuting speed of up to 16mph. It clocked 6.6 per cent of riding above 20mph, 29.5 per cent at 16-20mph, 43.1 per cent at 12-16mph, 13 per cent at 10-12mph and 7.7 per cent at 10mph or below.

There were no reported collisions between cyclists and pedestrians but two “near misses” a week were spotted.

Cyclist Jon Stone called the plans “horrifically stupid” as it would lead to riders diverting onto Park Lane. Another said: “Ripping up one of London’s busiest bike tracks, turning it into shared pavement, [is] dangerous for all”.

Simon Munk of London Cycling Campaign said the plan was “outrageous”. Cycling blogger Danny Williams said the Royal Parks was “actively refusing to listen”.

Cycling campaigner Dominic Leggett wrote to Mr Norman and Ms Shawcross asking them to intervene. He said the changes were “not justified by any history of collisions, and discriminate against least able cyclists”. He described them as “idiotic, unnecessary changes that will make a good cycle route uncomfortable and unpleasant for most”.

A Royal Parks spokesman said: “If we have cyclists racing up and down a pathway at speed with pedestrians trying to cross that really doesn’t make for a pleasant visit, especially when we also have cases of pedestrians being shouted at for walking on pathways in the way of cyclists.”

Mr Norman’s spokesman was approached for comment.

‘Extraordinary’ NHS documentary Hospital to return to Imperial, BBC announces

Tags

bbc2-hospital

The TV documentary series that has exposed crisis bed shortages within the NHS and the cost of “health tourism” by foreign patients is to return for two more series, the BBC announced today.

Hospital, which is filmed across Imperial College Healthcare including St Mary’s and Charing Cross hospitals, has revealed how surgical teams are at times unable to operate due to the lack of intensive care beds.

Described by critics as “extraordinary” and “brilliant and brave”, it has also shown how the NHS remains able to perform near-miracles despite the extent of the pressure it faces.

Pioneering operations have included heart surgery on a 98-year-old man. It also showed how Imperial was left with an unpaid bill in excess of £330,000 after a Nigerian woman turned away from the US went into labour on a flight home via Heathrow. Two of her four babies died.

The second series will focus on maternity care and mental health at Imperial. The location for the third series is yet to be decided. The first six-part series, which ends tonight, has averaged 2.5 million viewers per episode.

Patrick Holland, Channel Editor, BBC Two, said: “The first series of Hospital was everything I want BBC Two to be. It is timely, brilliantly made and challenging TV. It was editorially brave to make a series with such a short turnaround but it felt so timely for the audience.”

Simon Dickson, executive producer at filmmakers Label1, said: “Edited and broadcast within a few short weeks of filming being completed, it’s Britain’s first fast turnaround blue-chip documentary series. The audience figures prove that people crave the freshness and insight it offers.”

Future series will also extend beyond the hospitals to look at primary and social care, to understand in greater detail the complex relationship between them and the NHS.

Michelle Dixon, director of communications at Imperial, said: “Hospital has given us the opportunity to show the amazing care and commitment of our staff as well as the growing challenges we face as we respond to the changing needs and demands of our patients.
“It’s so important to develop a shared understanding of what’s happening in the NHS and what’s at stake. While the first series has provided a great insight to a whole range of issues and services, there is still much more to see.”

NHS rich list 2016: meet the 90 Whitehall health chiefs who earn £150,000 or more

Tags

, , , , , ,

professor-sir-mike-richards

Professor Sir Mike Richards: NHS’s joint best-paid Whitehall bureaucrat

NINETY NHS officials working for central Government and its quangos earn £150,000 a year or more, the Cabinet Office has revealed.

The best paid were Professor Sir Mike Richards, chief inspector of hospitals at the Care Quality Commission, and Frances Gould, a microbiologist with Public Health England. Her salary increased to £239,999 to put her on a par with Sir Mike.

Dr Jonathan Fielden, the NHS England director of specialised commissioning, was next best paid, with a salary of £224,999. Dr Fielden was appointed to the post last year on a salary commensurate with his previous earnings as medical director at UCLH, the Cabinet Office notes reveal.

He is the most senior official in charge of the controversial plans to reduce the number of hospitals providing congenital heart surgery, which has placed the Royal Brompton at risk.

Professor Dame Sally Davies, the chief medical officer, earns £209,000. Profesor Sir Bruce Keogh, the NHS England medical director, gets £194,999 – the same amount as Dr Andy Mitchell, who is standing down as medical director of NHS England’s London region, and NHS England chief executive Simon Stevens, who took a 10 per cent voluntary pay cut on his appointment.

Dr Anne Rainsberry, chief executive of NHS England (London), earns £165,000. Steve Russell, the former Barking, Havering and Redbridge trust deputy chief executive who heads NHS Improvement in London, receives £174,999. Duncan Selbie, chief executive of Public Health England, earns £189,999.

Seven of the 90 executives earned in excess of £200,000. In addition to the 90 taking home at least £150,000, a further three are paid the equivalent rate but work part time. The total pay bill for the 93 was £15,884,907.

The High Earners list does not take account of the earnings of senior executives at NHS trusts across the country, where most chief executives (and often several senior colleagues)  will be paid in the region of £150,000 or more. See here for some of London’s best paid hospital bosses.

Separate information released by the Cabinet Office reveals that Health Secretary Jeremy Hunt has three special advisors, earning between £66,000 and £75,000 (below).

jeremy-hunt-spads

Salaries earned by Jeremy Hunt’s special advisors

The annual High Earner figures, which names people earning £150,000 or more across Government, are available here: https://www.gov.uk/government/publications/senior-officials-high-earners-salaries

TV documentary to show reality of life on frontline of London’s NHS hospitals

Tags

the-stars-of-the-tv-documentary-hospital

Medics on TV (from second left): Rick Gibbs, consultant vascular surgeon, Ali Sanders, chief of service emergency care, Andrew Chukwuemeka, chief of service cardiology and cardiothoracics, Helgi Johannsson, chief of services for theatres and anaesthetics, Ruchi Syed, consultant paediatrician, Colin Bicknell, consultant vascular surgeon, Angus Lewis, consultant orthopaedic surgeon, Sadie Syed, consultant anaesthetist

The extent of the pressures on front-line NHS staff will be revealed after documentary makers won permission to film behind the scenes at one of London’s biggest hospital trusts.

A six-part series, Hospital, which starts on January 11 on BBC2, will show how staff at Imperial College Healthcare cope with competing demands from a growing number of sick patients while seeking to deliver high-quality care.

It follows staff and patients at Imperial’s five hospitals – Charing Cross, Hammersmith, Queen Charlotte’s and Chelsea, St Mary’s and the Western Eye. It shows patients being treated across a range of services, from cancer to cardiothoracic surgery and pioneering neonatal care for newborn babies.

Michelle Dixon, Imperial’s director of communications, said: “It’s not an easy decision to allow camera crews in to follow all aspects of daily life in our hospitals. But we think it’s really important to share the opportunities and challenges, the highs and the lows, with our patients and local communities. It’s their service as much as ours and the only way we can ensure we maintain and build on the very best of the NHS is by working together.

“The series will show the huge range of day-to-day activities, from the small acts of kindness that make a huge difference to an individual to ground-breaking research trials that change practice world-wide.

“We’re extremely grateful to the many patients, and their families and carers, as well as the staff who allowed us to show their experiences as part of the series.”

Imperial is the latest London NHS trust to grant access to TV cameras as part of an effort to educate the public in the dilemmas of providing care to a growing and increasingly sick population.

Earlier this year Ambulance showed how the London Ambulance Service copes with soaring pressures that often result in 999 callers being refused an emergency crew. St George’s, in Tooting, followed King’s College hospital, in Denmark Hill, in having its emergency department feature in 24 Hours in A&E.

The Hospital series is made by Label1, a new independent television production company whose founders have a track record in creating ground-breaking factual programmes.

  • An edited version of this article appears in tonight’s Evening Standard

Pedestrian and cyclist deaths deterring foreign students from studying in UK, warns university chief

Tags

, , ,

The head of a London university attended by a cyclist killed in a HGV crash today said the UK’s record on road safety was damaging the nation’s ability to attract foreign students.

Professor Aldwyn Cooper has written to Mayor Sadiq Khan about the danger posed by lorries in the wake of the “absolute tragedy” of the death of Italian prince Filippo Corsini in Knightsbridge in October.

filippo-corsini

Filippo Corsini: a highly-qualified cyclist who rode from Brighton to London for fun

Professor Cooper, vice chancellor of Regent’s University London, warned there was global awareness of the number of cyclist and pedestrian deaths – adding to fears about post-Brexit changes to visa rules.

He told the Standard: “This is making London bad news for students, bad news for parents, bad news for tourists. This last year we have had [almost] 20 people in London, on bicycle or foot, killed by lorries.

“If you look at universities at the moment, we are under such considerable pressures, due to concerns about immigration and visa controls. A lot of people in other countries around the world are starting to see Great Britain as a less attractive place to come and study. Anything that diminishes that motivation is very bad news.

“We are the gold standard for higher education in the world. It’s not just in London where this problem exists. Leeds, Manchester, Bristol – they have all got these kinds of problems.”

At least 13 pedestrians and three cyclists have been killed in HGV collisions in London this year, according to the Vision Zero London road safety campaign. A total of 409 pedestrians and 100 cyclists were killed in UK road crashes last year.

Mr Corsini, 21, who was studying for a BA in international business, was on his way to the university, in Regent’s Park, when he collided with the HGV on October 31. He died at the scene from “catastrophic injuries”.

Professor Cooper said he was an “amazing young man”. He said: “Filippo was a very highly-qualified cyclist. He trained under one of the top cycling coaches in Italy. He spent a lot of time cycling. The day before he was killed, he had cycled from Brighton to London for fun. Almost the last words he had for his sister were: ‘I love cycling.’”

The 42-year-old lorry driver was arrested on suspicion of causing death by careless driving and was bailed until early December. His bail has been extended until late February while investigations continue, a Met police spokesman said.

Last week the university was contacted unexpectedly by City Hall asking it to endorse the Mayor’s part-shelved plans to route the CS11 cycle superhighway on the park’s Outer Circle to improve safety for cyclists and pedestrians.

Professor Cooper replied by urging Mr Khan to bring forward plans to introduce a “star rating” for lorries based on the driver’s view of cyclists and pedestrians.

He also wants speed restrictions – enforced by police – for all road users in the park, saying two students were hurt by “speeding” cyclists who ignored red lights last year.

He said in a statement last week: “I have been in correspondence with the Mayor, Sadiq Khan, since the tragic death of one of our students six weeks ago while cycling to the university.  I know that the Mayor is committed to making London a far safer city for cyclists and pedestrians. Cycle Superhighway Route 11 should facilitate this. Of equal importance are controls on lorries. There are plans for this by 2020, but the sooner such limitations are imposed, the better.”

A spokesman for Mr Khan said: “Every time someone is killed by a lorry on London’s roads it is an appalling tragedy. That’s why the Mayor is introducing a world-first ‘Direct Vision’ standard for lorries in the capital, banning the most dangerous HGVs from London’s roads completely by 2020.”

  • An edited version of this story appears in tonight’s Evening Standard.