There has never been a clear long-term plan for the whole of West London

1.18 Reviews of London's health services in the 1990s focused on strategies for inner London, leaving strategies for outer London more fragmented and subject to short-term local planning rather than cohesive longer-term planning.

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Pan-London health strategy reports focus on Inner London
Strategy drivers in the NHS have changed over time
There have been some rationalisations of hospitals located around West Middlesex
Wider strategic issues resulted in the transfer of mental health services from Ashford Hospital to the West Middlesex site at a late stage in the procurement process