We’ve now had three local press reports claiming that Andrew Lansley’s proposals will somehow help our cause. If it wasn’t the budget constraints as reported in the Gazette a few weeks ago, much was made of there possibly being more local involvement in health decision-making as reported in the Tribune, (here was our reply published two weeks later) or that tricky unanswered question of who or what will own NHS assets as reported later in the Gazette. Here is the PCT’s version of last month’s events.
But what are those reforms? How will they affect our fight for the refurbishment and retention of Finsbury Health Centre as a home for local community health services?
Overall it is very clear that this Government is pushing further privatisation within the NHS, faster than intended by Labour, while paying lip-service to ‘patient choice’ and ‘bottom-up decision making’. Although there has been much play about giving power to GPs, they will only have control over some community services, and the real power will be with the NHS Commissioning Board which will commission the services GPs not within their remit (like maternity services), set practice budgets, set prices for services, ensure ‘competition’ during the commissioning process and oversee the ‘outcomes’ expected of the GP consortia. Basically the reforms leave everything wide open for more scenarios like the recent pulling of Camidoc’s out-of-hours contract in favour of a private firm.
Local democratic ‘legitimacy’ but not accountability
Democratic ‘legitimacy’ is given a nod with the proposal for local Health and Wellbeing boards. While these also seemingly could get involved in directly commissioning some health services, the mixed Health and Wellbeing Boards’ powers are not defined. The NHS Commissioning Board will have a seat on them, and will be expected to work with them and apparently come to mutually agreed conclusions. Again ultimately disputes will be settled by referral the Secretary of State for Health, who is retaining the Independent Reconfiguration Panel for investigation and advice.
The White Paper also appears to be giving Local Councils responsibility over ‘Public Health Improvement’ with the help of a new Public Health Service, and a Public Health Director to be appointed between them. ‘Public Health’ however, seems to only consist of everything which won’t generate a profit for private health firms, ie public health campaigns.
Effect on our campaign
So far the effect on our campaign has merely been to muddy things up, with both the PCT and Council using the prospect of change as an excuse not to do anything about Finsbury Health Centre.
It is true that there is nothing said in the White Paper about who or what will own the properties like Finsbury Health Centre still directly owned by the PCT. Equally unclear is who or what will control the 10% share the PCTs have in the local LIFTco, and who will be responsible for the leases they’ve signed with them. It’s anyone’s guess whether the property – and liabilities – will devolve to the local council, the local GP consortium, or the NHS Commissioning Board. Given this Board’s power over the GPs in terms of budgeting and spending however, it may well have a say over where and how community health services are housed even if it doesn’t ‘own’ anything. And if there are liabilities involved, bets are on that these will be devolved to local councils.
Since nothing at all is said about health buildings in the new White Paper, it might be safe to assume that the LIFT programme will be dropped, and thus the PCT’s primary excuse for ignoring our suggestion of using a not-for-profit trust to refurbish Finsbury Health Centre. On the other hand, since it is essentially a PFI arrangement, it may not, and the government may simply eliminate individual PCTs’ share in it. This government has made a lot of noise about more local control over community assets, but has stayed vague about how this is to happen. It will be up to us to campaign for this, and it may be that we’ll have to form a community trust sooner rather than later.
Otherwise the local ‘choice’ may be limited to Bupa or United Health Care.
While there does seem scope for more involvement of local councils in decisions over community health services, which given the support shown by all parties in Islington should be a good thing for us, this will largely depend on whether the Health and Wellbeing Boards have any statutory powers, and how energetically the Council takes up forming one if the legislation gets through. The increased powers of the GP consortia could also work in our favour, since most of the GPs currently working in FHC have expressed a desire to refurbish the building and keep it open, although again there is nothing said about who or what will own buildings, so no guarantee of actual public, or even GP, control.
All these changes are to be in place by April 2013, but in the meantime it makes sense for Islington Health and Wellbeing Review Committee to exercise its power to refer to the Department of Health in the wake of the PCT’s refusal to adopt their recommendations. The Independent Reconfiguration Panel seems to be the only body left unchanged by the proposals, along with its remit advise the Secretary of State on the basis of patient need and not finance. Given the PCT’s failure to either find any more evidence for what the IRP called a ‘weak’ patient need case or answer the Council’s financial recommendations, there is no rational reason why the IRP shouldn’t find in our favour. This then could apply to who or whatever takes over the actual titles to NHS property.
Also in the meantime, despite Lansley’s pre- and post-election announcements that he’s scrapping the Darzi Review mandates for polyclinics and the down-grading of A&Es in London, the local PCT is still pursuing the set-up of two polysystems in Islington under the umbrella ‘Transforming Primary Care’ and the down-grading of Whittington A&E with the new Urgent Care Centre. As of July’s PCT board meeting plans for the Southern “Neighbourhood Health Centre” (polysystem) publicly have been put on hold, although that then begs the question if FHC is abandoned what will happen to the services there.
As fast as the government is pushing the cuts if not its other changes in the NHS, there is still a lot to get through before these reforms become law. Basically the Government is proposing the final break-up of the NHS as a coherent and publicly accountable organisation, and the NHS Support Federation has started a petition against them which you can sign here. In the meantime we still have to deal with this PCT – it is to be hoped that the growing opposition to these reforms will not only defend the status quo, but make its own proposals for how the NHS could be run more democratically.
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