Haringey's health services

Surgery, then met new Head at Hornsey Girl’s School (what a great new head!), then had my usual meeting with David Sloman (CEO of Whittington Hospital – who assures me that my endless banging of the drum on how patients are treated in terms of care and compassion is now top of the list) and then on to Haringey’s new Sixth Form Centre to present a prize to one of the Haringey Heroes. This is an awards event for young people across Haringey who have showed exceptional talent, or caring, or leadership in their lives. For example – one was a carer’s award for children who have (on top of everything) to care for parents with disabilities. It is one of Haringey’s better efforts – and I was very happy to be there.

Thinking further about local health services – and watching Lord Darzi talk about the NHS plan – I am struck by the contrast between what he says – which is that polyclinics are about providing extra services – and what people are most worried about locally – which is that their doctor will be plucked from their current location and put in this amorphous ‘polyclinic’ further away.

It is still unclear to me – for example – whether our new local health facility (I doubt whether it will carry on being called a polyclinic) currently rising from a building site – will be only ‘additional’ as Darzi (and ministers) claim. When building is already taking place and this is still unclear, matters are far from as clear as they should be.

It is also still unclear what services will be provided on site and what say we the people actually will have. I have no doubt that the west of Haringey needs a new health facility and it is pretty difficult to get any money spent on us – as we are always in direct comparison to Tottenham where the need is obviously greater as an area of high deprivation and unemployment. However, there is plenty of need and unemployment this side too – and quite frankly – we all need and are entitled to proper health provision.

Polyclinics: panacea or plague?

Polyclinics are turning out to be one of those slow-burning political issues which, although getting the occasional piece of news coverage, have really been bubbling away in the public’s mind and concerns for a long time before really grabbing the forefront of political attention.

The possible introduction of polyclinics has been an issue in Haringey for some time now, and it’s a topic I’ve blogged about moderately regularly – but nearly each time I’ve been struck when going to research further information on the topic or to see what other people have been saying, how little attention overall the issue has been getting. Yes, there’s been the occasional news story and occasional reference in Parliament, but for an issue that could massively alter the way tens of millions of people get their health care via the NHS, it’s really been pretty low key.

The recent news that over 1 million people have signed a petition on the issue – along with the major Kings Fund report into the topic – may well change that now!

I certainly hope so, because the introduction of Polyclinics, or Neighbourhood Health Centres, or whatever the government has tried to re-brand them as this week is the biggest health issue facing my constituency – and many others – at the moment.

The idea behind these centres has some attractions – bring different health services together on one site so that you can move quickly and easily between those services without the usual delays (go to one place, get referred to another, wait for appointment) or the extra travel.

Haringey’s Primary Care Trust has chosen to be a trail blazer for Polyclinics and has enthusiastically adopted the idea. The current proposal is to close a number of local GP’s surgeries and consolidate them into four or five Polyclinics.

And that’s where the concerns start. Will these become large impersonal services where we are no longer able to see our own local doctor? We need guarantees that the relationship with your doctor will continue. Any severing the doctor/patient relationship would be a travesty. Hardly anyone wants to explain a deeply personal medical problem to a complete stranger.

Consolidation of GP’s will undoubtedly increase journey times for many people wishing to see their GP, and force them to take either public transport or their car. The heaviest users of primary care have low levels of car ownership (senior citizens 69% no car; lone parents 42%).

It’s easy for those of us who have no trouble getting around to under-estimate just what a burden it can be to extend someone’s 10 minute journey into a 30 minute with two bus changes journey.

The site of the old Hornsey Hospital is where one of the proposed polyclinics is to be built. This site is currently served by only one bus route and it takes Transport for London anything from two years to establish a bus route. This means that those with the most need would most likely have the least access to the service. I met with TfL and raised the issue of public transport provision to this site several years ago and recently raised it with Peter Hendy – the Transport Commissioner for London. But as yet – no firm plans.

Sorting out adequate access to the services should be central to any polyclinics plan – not an afterthought to play around with after the service is in place and people are already suffering from poor transport links.

The recent report by the Kings Fund concluded that there were “serious risks to access to care” posed by consolidation of primary health care and that “it is unlikely that the gains in access to some services currently provided in hospitals are worth the losses for primary care patients.”
Accessibility of service, both in terms of getting an appointment and getting to the appointment, is vital – especially as 90% of access to the NHS is via the primary care route.

And then there is the question of whether polyclinics will really add to our services and facilities? Or will consolidation mean – as it has in so many other areas – cuts?

That brings me to the problems over how the policy is being pushed through – without proper consultation or information. It’s a central imposition of Labour’s ideas on to local communities. Local health bodies have been instructed by central government that they must have polyclinics in every community. This is a classic top-down, Whitehall imposed centralising solution to local problems.

As with our post offices, we were promised that local opinion would be taken account of through consultation. Yet so far we have not been told precisely which services will be provided by polyclinics. This renders the consultation process pretty meaningless as we cannot make an informed choice about what we will gain. And so we are marching on blind – not knowing and having to keep our fingers crossed.

Getting the wheelchair you need

After several hours of angst at Friday surgery – it is pretty draining sometimes – I go off to the Bernie Grant Centre to give a speech on Primary Health Care in the borough. This event is hosted by Camidoc – who are the current providers of Out of Hours Service (OOHS) in ours and three other boroughs.

Their contract has just been extended to September ’09 – but this service will be up for tender at that point. My fear is that Haringey Primary Care Trust will use a private provider – perhaps some big company – that has no local base and no local experience. I can’t endorse any provider myself – obviously – but I will say that I have used Camidoc extensively (given my children seemingly only ever tell me they are ill as the doctor’s surgery closes on a Friday night!) and found their service very, very good and very professional.

Anyway – most of my speech was about the proposed polyclinic scheme and how we, the human beings, want our local GP to remain our local GP. The clinics may be super duper – so long as they provide extra services and in consultation (real consultation) with us provide what we want in accessible form.

Then on to see a lady whose daughter was perfectly normal until the age of 13. She loves music, films, drama, clothes, shopping and spending her parents’ money (so her mother told me). She was bright, did very well at school and was very active at sport. She then developed Rasmussen’s Encephalitis, a rare neurological condition which presents as intractable seizures, and loss of function on the affected side. She had a hemispherecomy operation in April ’06 which left her paralysed on her left side with significant cognitive and visual difficulties. She is gradually regaining some mobility but will never recover the use of her left arm and hand, her fully cognitive functions or visual field.

Anyway – the point of my visit was to highlight the appalling provision of wheelchairs. You can have the basic model – which means you have to be pushed by someone else – but you can’t have a powered chair unless you fit very, very strict criteria. The daughter has already lost a lot of confidence. Being able to move yourself is all the difference in the world in terms of independence. Otherwise you kind of become someone who waits – waits for someone to push you. You have no power over your own life. No independence. I think this is vital. As if it’s not bad enough to have a disability which means you need a wheelchair for all or some of the time.

(There have also been some health and safety arguments wheeled out as to why a powered chair won’t suit in this case, but they don’t stand up to close scrutiny.)

We shouldn’t have a health care system that says you have this basic chair which will condemn you to always need someone around to push you – will give you no independence – and which is cheap (basically).

Visiting the Whittington

Having done my usual advice surgery this morning, this afternoon I met with David Sloman (Chief Exec of the Whittington Hospital). We had our usual discussion on the progress of their application for foundation status – which is seemingly progressing.

We then went on to discuss the issues around the Hornsey Hospital development as I suddenly saw a real possibility of how the new facility could be made to work well. David was saying that if the IT system that is installed was linked to all local practises and the Whittington – then we (the people) would get a proper health network whether we went to our local GP, or were referred on to the polyclinic (click here to read about polyclinics) or the Whittington. Also, he was saying, that it would be more natural if the local health trust were to commission the Whittington say, to facilitate the phlebotomy department (taking blood) at Hornsey Hospital or other natural extensions or outposts of the services.

Anyway – the point I made was that David needs to make sure he (and the Whittington) are at the table with the GP practises et al when the specifics of the new health facility are being hashed out. That’s why I keep saying – it could be great or it could be a disaster – it will depend on real, real partnerships and not the Trust simply saying this is what you will have.

Plans for the NHS

Well, well, well! So Health Secretary Alan Johnson has outlined plans which aim to make the NHS more user-friendly for patients in his speech to the Labour conference. He said patients should be treated close to home and GP surgeries should open “at times and in locations that suit the patient, not the practice”.

I will be quoting this incessantly at Haringey PCT if they try and move our GP practises into the polyclinics! That’s the point I keep making. We need to be treated close to home.

As for this shenanigans with Brown and the election – a real man, a real Prime Minister – would put the country first! I rest my case!

Meeting Peter Hendy

Wednesday evening met with Peter Hendy, Commissioner of Transport for London. My three asks were: extending the 603 bus route to run all day and evening (as always); the transport issues around the new London Health Trust plans including the polyclinics (we need to ensure there are good public transport links for any such); and whether he would think about encouraging car clubs (where people share cars) via a congestion charge incentive.

So – number 1 – the 603 bus from Muswell Hill to Swiss Cottage. Well – the possibly good news is that it comes up for review next year. So our job is to make sure we feed into that review with thousands of requests to extend the operating hours from its current school run times only. People keep asking me about this – so we will have to ramp up our campaign again.

On number 2 – well it was interesting – because there are huge transport implications in the proposals to restructure health services. Firstly – the need to access in emergency for stroke, heart attack and major trauma the proposed super-specialist hospitals. Surely travel time trials from every part of London need to be done to establish the worst scenario time taken when traffic is bad and no air ambulance available? If we can’t get the victims to the right place in time – then this plan won’t work.

Secondly, the establishment of polyclinics – which are to serve up to 50,000 residents – may raise big transport issues. Will people be able to get to the polyclinics in reasonable time and at reasonable cost?

Peter was saying that this could be an issue and was going to arrange to meet with the Government to talk over the transport implications. Hurrah!

On number 3 – yes – Peter is considering how best to encourage the expansion of car clubs – so he agreed to look at the congestion charge in that regard – but I think any discount will be along the lines of discounts to people within the zone but not outside. Anyway – it is in and on his mind.

Update: you can read my article subsequent article about polyclinics here.

Muswell Hill Library and Hornsey Central Hospital

Muswell Hill and Highgate Neighbourhood Assembly – centred for its theme on older people in the area. Featuring were both the plans for Hornsey Hospital to become a polyclinic and the abandoning of the idea from Haringey for a restaurant in the centre of Muswell Hill Library – at which we cheered as the detailed case had never been made for it.

On the rest of the plans for the library (which is much in need of care) – there was still no timetable at all – and the Director of Libraries who was there didn’t know the timetable and didn’t have information about some of the basics of the plans. Not impressive. And the tragedy is that some of the ideas that have been talked about have been excellent – but it’s all being lost in a mess of vagueness and foot dragging.

And then the poor woman presenting the Hornsey Hospital update got it in the neck for the shameful consultation process taking place at present on the local Primary Care Strategy. Sue Hessel said that only seven people attended the first meeting and the second which is tomorrow night may attract just as few. They said they were happy to go to other meetings if invited but as I pointed out – having a meeting isn’t consultation – nothing like. So I’ve written my Highgate Handbook and Muswell Hill Flyer column on this issue (will post after it is published) as local people need to know what is going on.

Update: my article about polyclinics is now here.

Avenue Gardens Residents' Association

Spend the morning in Ealing for the by-election. Seems very jolly over there and upbeat. Main community event of the day back in the constituency is going to Avenue Gardens Residents’ Association to do a ‘Question Time’.

Key issues from the evening included Haringey’s lack of consultation with residents over planning proposals – in particular – Haringey Heartlands. And – even if there is a consultation – they ignore it.

One resident raised the issue of the proposed polyclinics – and the potential of these plans to denude us of our local GP practices. That is what we need to make sure doesn’t happen.

It was interesting when I met with the Trust and asked what I would think is a critical question – what proportion of GP visits require further action (diagnostics, referrals to a clinic, etc), they couldn’t give a full answer.

But this is key to the polyclinics idea – because if, say 90% of doctor’s visits require follow up with one of the services that will be at the polyclinic – then having the GP and those other services all on one site can have advantages of saving further trips (and so further delays). But if those 90% instead don’t require further services, then having GP practices centralised isn’t nearly so attractive.

Anyway – back to Avenue Gardens Residents’ Association – we also ranged over excess of traffic, HGVs, the tick-box society, the quality of councillors, the poor quality of decision-making at Planning Committee, and other topics too. I enjoyed it – as I always do. Meeting people at events like this always reaffirms the point to the whole process. It is always about peoples’ lives!

What's a polyclinic?

Main meeting of the day was with Richard Sumray, Chair of Haringey Primary Care Trust (PCT). For me the key question was around the proposals for Hornsey Hospital which has now become part of the wider Primary Health Care Strategy. This strategy proposes (and is part of the London-wide strategy as well) something like six polyclinics in Haringey.

Hey – what’s this poly thingamajig – I hear you say. Well – it’s a sort of community hospital without beds – i.e. it’s a super, duper, all singing all dancing health facility with clinics for various things like diabetes, services like chiropody, diagnostics and the kitchen sink. I say that – because the array of services proposed for Hornsey Hospital is yet to be consulted on and we hope (despite our experience – so hope against hope) that the services can accommodate what local people want not simply that which is prescribed by the PCT.

There is some confusion around consultation because there is a consultation by the Enfield Haringey Health Trust on the local Primary Care Strategy – which is really with health stakeholders etc and then there is also to be a consultation on Hornsey Hospital itself.

The polyclinics really come up in the Primary Care consultation – and this may contain the key issue which I believe is what loss will there be of our local GP practices as part of the move to polyclinics? The idea is to improve local health services in these new facilities and provide some of things we are used to going to the hospital for nearer to home.

But the polyclinics will need some rental income, I believe, from GP practises based in the polyclinics. Of course – if a local GP practise moves into a polyclinic – it may mean for the ordinary person who is ill, just needs the doctor and a prescription or not without further treatment, a longer journey. That in turn raises issues of travel, access, car usage, parking and public transport connections – all very difficult.

So – on the individuality of each polyclinic – including Hornsey Hospital – Richard promised me that there would be a separate consultation – a continuance of the public meetings twice a year that we all have had on Hornsey since it was closed. I would also wish to put pressure on the consultation to demand that no area of the borough should be denuded of a local GP practice – and that any practise or doctor who wants to move in to a polyclinic ought to consult with their patient list.

The polyclinics sound great – but we have to make sure that local people have a say in what is provided and a say in what happens to their local GP practices and that there is a net gain. Perhaps local people want out of hours services, doctors that will visit in the home (which might solve some of the access issues as you don’t feel like getting on a bus when you are sick), and so on and so on.

There is so much involved in all of these changes – I have to say to people get involved, respond to the consultations. I am happy to have a spanking new facility on the Hornsey Hospital site as has been promised to me and local people for years now – but it has to deliver a great slab of what local people want and not remove the very local doctors that people rely on.

Update: you can read my article subsequent article about polyclinics here.

The future for local health services

Straight on to meet David Sloman, Chief Executive at the Whittington. His issues are around the Health Strategy for London which will begin on 11th July and the Whittington’s own move towards foundation status. This is a bit different from Fortismere’s problems – firstly it is mandatory as the Government as decreed that all hospitals must do this within the next few years. What the Whittington gets out of it is the ability to plan for the long term, revised engagement in terms of real community voices in decision-making, legal and financial freedom. I will consult with colleagues on this in due course.

On the London-wide strategy: some of it seems ok – like stroke victims and heart attack victims going straight to special centres – so long as there are enough in London (i.e. not just shipping people miles away, especially as the first hours are so vital). The local community hospitals like the Whittington are fine too.

Where the battle lines will be drawn – and this refers back to what I said about Hornsey Hospital and the proposed polyclinics. For example – there will be something like five or six in Haringey each serving up to 50,000 residents and will provide super-duper clinics, diagnostics, etc etc. However, it will only financially be viable if they bring in our local GP practices to operate from there. Now – I wouldn’t mind if they swept up the individual single-handed or two men doctor practises and put them in there – that would be improving the service – but I bet they will be after our other practices and I don’t think the community will want to have the normal visit to their doctor that doesn’t require other services moved away from the local.

Maybe I am wrong. We do want after hours services which would be provided on such a site – but I though that the huge hike in doctors pay and contracts was to create extra provision. Ain’t seen nothing yet! So I suspect that may prove controversial. Polyclinics – great – but don’t take away local GP practices.