Is FHC ‘saved’ or only half-way there?

After the HWB meeting 2 Sept and the headlines last week, there’s finally time to sit back and assess the situation. Apologies for the rushed and possibly opaque recent posts, and now this very long one; any and all comments warmly welcomed.

We have won quite a lot so far, first and most importantly general support from a very wide range of people in our immediate community, community groups, people working both in FHC and widely in the NHS, and local businesses. Then there were over 2100 signatures on paper and online to our petition; support from all political parties; referral to the Department of Health; support for our position after ‘the most thorough scrutiny review ever’ by the council’s Health and Wellbeing Review Committee; three supporting resolutions in the Council; a question in parliament which put the new government on notice; a further formal ‘consideration’ of the issue by the PCT, even if it didn’t go in our favour.

Along the way we’ve raised some important general questions. These have included: the lack of democratic control of the PCTs which run primary care services; the inflated salaries of the top executives and generous stipends of the non-execs privately chosen to oversee them; the fiscal insanity of selling NHS property and committing to a sum three times capital cost; the inequity of VAT rules which apply it to refurbishments and not new-builds; the need for ‘evidence-based decision making’ to actually have an evidence base. Then there is the bizarre semantic world of health policy, where FHC was a polyclinic, but can’t be a Polyclinic or part of a Polysystem, and the word ‘overperfomance’ means both staff working more than they are meant to and a budget surplus.

The most important victory is that Finsbury Health Centre is still open, with most of its primary care services in tact. By the PCT’s original timetable, all but the GPs were due to have left by this time, with the GPs to move to a new building next door at the end of this year. It is looking at the moment like the PCT have no choice other than to use it, and now they also have a notice to repair from English Heritage to contend with.

Council resolutions?

Now there’s the promise that this issue will be referred back to the Department of Health pending further investigation next month. At the last HWB Ctte meeting SaveFHC supporters contended that there is enough evidence for referral to happen immediately, and that the search for  details about how trust funding could happen during that process and be submitted in time to be considered as evidence. After several speeches proclaiming that the building has been saved already, councillors decided to wait a month to try to pin down the funding options, and here we are.

Press reports

Since that council meeting we had a front page article in the Tribune proclaiming ‘Saved!’ (taking the councillors’ line), another in the Gazette also ‘saved’, with quotes from the PCT about how now they ‘have no plans to sell the building’ and are now looking at ‘charity funding’ to pay for refurbishment, and another in Building Design, with a quote from the PCT claiming that they ‘will work with the council to see if there are other options, such as charitable funding, for repair work.’

Please note these are only quotes from the press rep of the PCT, and not even the senior one. Officially the PCT have rejected the Council’s recommendations to keep the building and refurbish it. Or even spend any money at all on their planned £9.1 million new-build South Islington Health Centre. So far we have not been able to get information about where this ‘vision’ was to be built or what exactly was to be contained therein.

You might have noticed a similarity between this last figure and the one the PCT refused to spend on Finbury Health Centre.

That trust idea

A community trust along the lines set out by Richard Sykes at the last HWB meeting, or Heritage of London Trust Operations, or a combination of the two, especially if the next-door Pine St site is to be re-built, seems to be a reasonable way to proceed with refurbishment. Cllr Klute, Sykes, John Allan support the idea and Klute has had support from other Council members. Moves are underway to pin down the possibilities.

We originally founded ourselves on the idea that the NHS should pay. Certainly, as many of our supporters have said, it is shameful that the government has never simply taken responsibility for local NHS neglect and forked over the money for refurbishment. After spending billions on a handful of banks, even £10 million doesn’t seem like that much for a building which provides healthcare to over 20,000 people a year. When early on then Chief Exec Rachel Tyndall told us she would ‘knock it down tomorrow’ if FHC weren’t listed, however, we realised we’d need something else up our sleeves.

Thus the community or not-for-profit trust idea, which Sykes first outlined at our meeting in November 2008. Some of our supporters have worried that this is still ‘the thin end of the wedge’ leading to privatisation. Fifteen years ago maybe we could have held that line. After spending nearly the same amount of time fighting for the building as it took to build, and after the NHS has spent nearly five times that neglecting the building and looking for a reason to abandon it, something needs to happen. A community-led, not-for-profit trust seems a much better idea than a company run essentially by Barclays Bank. Or United Health for that matter.

Saved from both developers and banks

The irony is that the PCT’s original decision to close actually saved Finsbury Health Centre from sale to a part-government, mostly private, entity called Camden and Islington Community Solutions. Few may have noticed this if refurbishment had simply gone ahead. Indeed few have in the rest of the borough, where under this scheme, called ‘LIFT’ by the last government, the PCT has ended up committing itself to spending, over 25 years, three times the original capital costs on several buildings in Islington already. The White Paper is silent about this scheme, and about what will happen to NHS property in general. Some councillors have expressed the hope that NHS property might devolve to local councils. Are they ready to take on the liabilities?

The PCT still own the building and run the services. They look like doing so for another two years at least, however the government might try bribing people to leave early. In the meantime FHC staff and patients are suffering from the PCT using the situation to refuse to do simple equipment upgrades, and of course are putting up with a building which all agree is greatly in need of modernisation.

So how far?

Half-way has been a long way. Our campaign won’t be satisfied, however, until we’re toasting a sensitively restored and modernised Finsbury Health Centre, doing the job for public health services it was meant to do, and as beautifully as originally intended.

The PCT is just going to have to eat into that £14 million budget for ‘capital spending’ (buildings) to do the immediate repairs. The backlog from the last 15 years comes to nearly £2 million – and whether decided by NHS Islington (PCT) or, as looks increasingly likely,  by the same North Central Sector Trust (prop. Rachel Tyndall and Paula Kahn) threatening the Whittington, money is there. It would certainly be a far better way to spend the £2 million agreed for a new ‘Urgent Care Centre’ at the only recently rebuilt A&E.

Any community trust or charity funding should be reserved for the full deal, not a patch-up job.

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