Round four nearing finish

This next Monday 1 March the Health and Wellbeing Review Committee will be deciding round four of the fight to keep Finsbury Health Centre open. Their draft report is here. Since councillors in both parties know what’s good for them in the run-up to an election, and NHS Islington Chief Exec Rachel Tyndall has turned her back on any discussion of keeping FHC open, it looks likely that round five will be at the Department of Health.

It would be great to be able to assume that the Secretary of State will pay attention to the facts and make a rational decision, mindful of what is real value for money and excellent healthcare. If he does, and even just skims the evidence diligently collected by the Health and Wellbeing Review Committee over the past few months, he could not fail to order the PCT to keep Finsbury Health Centre open. The sad reality is that he is likely to need quite a bit of encouragement to keep his mind clear.

All London healthcare at risk

We went to a meeting last night at the British Medical Association called ‘London on the Brink’, based on John Lister’s recent report of the same name, along with about 200 medical staff and campaigners from all over London. A series of doctors described the effects of the NHS’s current blank paper thinking in different localities and specialities, and what staff has done and can do about it. Lister described NHS London’s plans for extensive cuts across the city – to hospitals in particular, with many to be broken up into a range of euphemisms for privatisation scattered around the city.

From the map we were shown, essentially the plans mean that your nearest 24-hour A&E could be more than five miles away. The capacity of politicians and bureaucrats alike to ignore actual costs, clinical excellence, geography and logic came up time and time again. There have also, however, been successes against stupid, management consultant-inspired initiatives when they are strongly resisted.

Medical staff were urged to stand up and be counted in the face of these cuts. We’ve had a lot of support from medical staff working inside Finsbury Health Centre, but very few have felt able to be public with it. We hope that will change, because they are in the best place to challenge so-called ‘clinical models’ coming out to bolster management consultant ‘blank paper’ thinking. Or at least they can say what they know about their own and patients’ needs, since as Lister said, NHS London, as well as our local PCT, is loathe to divulge the reports which they claim are dictating their decisions.

The aim, however, is clear – to break up the NHS into isolated, readily privatisable services and sell-off as much land as possible. And, it seems, to pay as much interest as possible to the banks for what premises the NHS does use, whether or not it can afford staff to provide healthcare in them.

Letting the sun shine in

Our campaign has managed to throw open the doors on one of many similar closed-room decisions around London, and its basis on cost, transport, and the unsuitability for adaptation haven’t survived the light. Much the best evidence for South Islington’s need of Finsbury Health Centre, scatter maps of where users of different services live, eventually came from within the PCT itself; the executive ignored them when making the decision to close. Those clusters of dots are impossible to spin, and the PCT didn’t even try when they came to light over a year and a half later.

We have often heard Tyndall and other PCT executives talk about how they’d ‘rather spend the money on doctors and nurses’ – as though where they work and what kind of building they work in is incidental. As though front-line medical staff is really what the PCT want to spend their money on. Tyndall alone cost the NHS two nurses with her salary rise last year.

Cost and value slug it out

Those of us who started this campaign felt from the start that there was no reason why the NHS shouldn’t be able to afford the refurbishment of Finsbury Health Centre itself. The PCT’s record on maintenance (none in 15 years but save sign-changing it seems) and its foot-dragging over the six years it had money from central government designated for FHC, led us to despair that even if we won the argument the job would still be done at too much expense (30 million over 30 years for possibly £10 million worth of building) and probably not very well.

What we didn’t know until after we started was that under the current central government guidelines, the building would be sold off anyway, to a shadowy part-NHS, mainly privately owned company called a LIFTco. Under various guises using the words ‘community’ and ‘solutions’ or ‘partnership’, there are people supporting this programme nationally who help the NHS spend an obscene amount of money on lawyers, accountants and fat mortgages for banks. In our case specifically Barclay’s.

This is why we have suggested that an non-profit trust take over the building’s refurbishment and maintenance. Since it is such an historic, internationally well-regarded building, grant-funding could well mean refurbishment for no net capital cost to the NHS, and a far lower yearly charge than the £1 million a year claimed by the LIFTco.

We realise, however, that this would not be possible for most NHS buildings, and in principle there’s no reason why the NHS could not itself hire competent people to build and look after its buildings, funding and owning them directly. The NHS could afford three to six buildings out of every one they’re getting now under various PFI contracts.

Tyndall, who told us back in 2008 that she would ‘knock Finsbury Health Centre down tomorrow if it weren’t listed’, was herself the source of some worry, since it seemed impossible that anyone who felt such obvious antipathy towards the building would be able to effect a good refurbishment of it.

Who makes the decision?

What our campaign has really been up against, however, is an entirely unaccountable system of healthcare governance. As we told the HWB Committee, it is not an accident that Finsbury Health Centre was built by a body directly elected by the public, with clearly divided committee responsibilities and overall power over local public services. FHC was originally built in half the time it has taken the NHS to argue about it, to clear clinically-driven guidelines and with a compassionate architectural eye. This combination ensured the building’s immediate popularity, even though, as architect John Allan has said, it must have looked like it landed from Mars at the time. It didn’t need a prior sham ‘consultation’ with the public because those responsible had already consulted their own direct knowledge of the public’s experience while it was being planned, and their arguments and budget were open to public scrutiny at any time.

It is absurd that these days, it took several Freedom of Information requests by SaveFHC, and the HWB investigation, to bring to light not only the costings the PCT was using, but several other key documents. Worse still, even after our elected local representatives have investigated an NHS decision in detail they have no direct power to change it. Perhaps if they did and the non-execs on the PCT board were themselves directly elected, the executive officials would not feel so free to ignore public feeling, population trends, geography, transport and real costs – to say nothing of clinical, functional and aesthetic excellence – as they have with Finsbury Health Centre.

And now, it seems, as they are trying with the Whittington. Join us with the rest of Islington, Haringey and Camden on the Save Whittington A&E march from Highbury Fields 12 o’clock this Saturday, and at the Health and Wellbeing Committee 7.30 Monday 1 March at Islington Town Hall.

We did everything we could to avoid a boxing match over this issue, but now that it is one we mean to win. Let’s let NHS executives in whatever grouping know that we’re ready for round five at the Department of Health.

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