Public+services+-+health+services+-+Local+campaigns+-+Save+Our+Local+GPs+-+What's+wrong+with+Polyclinics

= = = = =Save Our Local GPs / What's wrong with Polyclinics=

November 2007

I enclose (below) the Better Local Healthcare Campaign consultation response to the proposal that the former Hornsey Central Hospital site now becomes a Polyclinic. The consultation period has just ended. Please take a look as it probably is the most comprehensive local critique of the venture! Co-written by Linda Lennard (Consumer Policy Consultant) and myself (background Social Policy and Social Work ) it condenses the issues for you. Although is relates mostly to the Hornsey proposal the issues relate to all four proposed polyclinics in Haringey.

The $64 million questions are which local GP surgeries will be forced to close, and what will actually be in there in this polyclinic in, say, ten years time. (The foundation stone of the original cottage hospital read 'To the glory of God for the benefit of the poor').

In 1998 it was publicly stated that Hornsey Central Hospital would be retained. By 2000 we were told it would be replaced with sheltered housing and 64 respite and continuing care beds. In 2004 we were told it would be a 'community hospital', in 2006 that we were getting £7m. from central government towards it. (We got only a fraction).

We were not informed that they were selling off Fortis Green Clinic, the public have never been consulted on that sale or the sale of the Nurses Home land. We have now learned that they are closing local GP surgeries and putting them in this polyclinic together with their 50,000 patients.

There have been no services provided by the PCT for dementia in the west of the borough for 7 years now. The needs of the elderly and those with learning disabilities have been shamefully disregarded. The PCT continue to refuse to fund any facilities on this site for patients who require overnight treatment or care. There is now no hospital in Haringey and impending closures and reductions of surrounding hospitals! (The polyclinic may offer some diagnosis but not hospital care.)

All of this has occurred against a shameful lack of public consultation, public debate, public meetings (they held none in 2005) and public truth.

Thanks

Sue Hessel - BLHC - Vulnerable Groups officer of the Haringey Federation of Residents Associations

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Better Local Health Care Campaign **- Consultation response to PCT**
The financial arrangements of the scheme on the former Hornsey Central Hospital site underlie the problem of what can now be delivered from a “polyclinic”. This is essentially a commercial enterprise in which the PCT have tied taxpayers to a property development, in which a company will build a new structure on the site for £10 million, and charge rent to the taxpayer of at least £37 million over the next 30 years. I say “at least” because a PFI (which is essentially what this is) often increases charges as costs increase.

This contract places the public sector in a position in which payment of over £1 million annual rent will have to be collected even before payment is made for the services that go in there. Until 2039! Future policy makers will have their hands very tied, and it seems almost inevitable that only lucrative self financing medical (or non-medical) activities will be able to afford to run from there.

The payment of expensive rents would leave little in the public pot for the sick, vulnerable and poor. Already Hounslow and Newham cannot run local authority social services from their flagship polyclinics because the local authorities cannot afford their expensive rents. PCT documents assume Haringey council will pay half of the rent for the next 30 years - but at the Scrutiny Committee Cllr Bob Harris (Adult Social Services) warned that the local authority had not been consulted.

At the Scrutiny committee, the PCT admitted they don't know themselves what services will be in the proposed new building. So far all we know is that the ground floor will be rented to a super sized pharmacy with a proposal for retail and café space. But our community is not short of any of these facilities and there is a real concern that a large pharmacy could put our existing provision of more easily accessed local pharmacies out of business. The dementia day centre also on the ground floor will be paid for by a local charity, with an assumption that the local authority will rent and staff it.

A GP polyclinic is likely to be a relocation of GP services, not an expansion If GPs are put in the polyclinic they will have to be housed upstairs. This will create difficulty for patients with infants and the disabled, and is far from ideal. There is confusion about the latest proposal for GPs to relocate there with patient lists totalling 50,000. Few members of the public are aware of this proposal, and it would be undoubtedly be very unpopular as local GP surgeries are well liked as they are, and already offer a plethora of services. A proposal of this magnitude would inevitably lead to the closure of many local GP practices and will have huge implications for those sick, disabled and elderly patients who will have to travel further to a less personal and more centralised setting.

If the polyclinic houses GPs, their staff, infrastructure and their 50,000 patients it is difficult to imagine how there will be room left for any other services. There are many unanswered questions. Will there be a fully staffed and lead lined X-Ray room? The consultation literature suggests that diagnostic provision will simply be privately supplied on a part-time portable basis. There is a suggestion of a minor injuries unit, but it is unclear whether or what medical operations will be undertaken. Will these be performed by GPs? Surely most patients would prefer specialists to perform operations. Will an anaesthetist be on hand?

These questions are critical because no analysis has been made about what happens in an emergency - In an A& E setting there are specialist medical teams on hand if the patient suddenly worsens. - A&E hospitals have ambulances on standby. Park Road is already congested It would already take at least half an hour there and back for an ambulance to bring a patient to the Whittington Hospital. A development of this magnitude will already have huge implications for traffic congestion.

There are no beds, or hospital nurses planned at the polyclinic, so where are the plans for patients who require overnight medical supervision? Patients have not all got families who can care 24/7, and it is not always possible. Sometimes patients are too ill!

There are many vulnerable groups whose needs are not addressed in this scheme. Regarding social care, where are the promised respite and continuing care beds? Where is the promised sheltered housing? This is vital support for families.

Apart from what remain of our GP services, the proposed facility at Hornsey will be the only NHS health resource/ polyclinic in the whole of West Haringey. There are no NHS general hospitals left in Haringey. The 1980s saw the closure of both the Wood Green and Southgate Hospital and the Prince of Wales Hospital, Tottenham. When Hornsey Hospital was closed this was the last hospital to be sold off. On top of this Haringey plans to reduce provision at St. Ann's and there are national proposals to cut the number of beds and hospitals. Those without private medical care could be left with very little.

Officer for Vulnerable Groups, Haringey Federation of Residents’ Associations**
 * Sue Hessel B.Soc.Sc, M.Sc (LSE) Social Policy and Social Work

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September 2007
= = =Absence of concrete plans=

There is no detailed information publicly available regarding precisely which services will be offered at Hornsey Central Health Centre.

The current consultation document – //Developing World Class Primary Care in Haringey// – does not contain specific details on what services are intended to be provided on the Hornsey site. Instead the document sets out a series of aspirational objectives as to the kind of activities and opening hours that could be available at a super health centre. It does not say which services will be provided.

In August 2007, the Chief Executive could not say definitively what additional services will be provided there. The PCT is apparently working with local GPs to design the new services and care pathways for West Haringey. But there is no information as to which GPs are involved nor whether their patients will consulted and involved as well in the process.

In the absence of such crucial information, it is impossible to see how the PCT can carry out a meaningful public consultation. The PCT’s plans appear to depend on what GPs and the local authority will offer.


 * Key questions:**


 * What services will definitely be provided at Hornsey Central Health Centre?
 * How will the proposed provision of services, including centralisation, be an improvement on the current situation?
 * Which services will be NHS-provided and which services will be offered by private providers, such as diagnostic facilities?
 * Which services will be available permanently at the site and which will be provided by mobile visiting facilities?
 * What is the evidence base and how does this relate to the PCT’s plans for the site?
 * Has a detailed impact assessment been carried out on the implications of the plans, for instance, the implications for people with limited mobility of having to travel further for GP and other primary care services, and the environmental effects of centralisation of services on transport; or the implications for local pharmacies of a pharmacy being located at the site?
 * Which local pharmacies have been consulted about the plans for a pharmacy on the site; what has been their reaction; is it likely that a local pharmacy will re-locate there; will Assura Group’s pharmacy division provide the pharmacy?

=Absence of proper consultation strategy=

The PCT does not appear to have a clear and detailed consultation strategy. The current consultation document lacks detail; it is not written in an accessible and easily understandable form; and the questions are too broad. No options are offered for consideration.

Proper consultation depends on meaningful information being provided in an easily accessible form as early as possible in a decision-making process. A few meetings have been held which have ostensibly included discussion of the document but in reality these have been woefully inadequate. Little concrete information has been provided to inform discussion.

The PCT does not appear to have any strategy to engage with local people in a systematic way. The current consultation exercise is fundamentally flawed, excluding, and discriminatory. For instance, patients of local GPs should be consulted, and efforts should be made to reach older people and disabled people who may not be able to go to public meetings. Documents should be made available in a range of languages and in a variety of formats including large print and tape.

The Cabinet Office’s Code of Practice on consultation for government departments sets out six consultation criteria:


 * 1) Consult widely throughout the process, allowing a minimum of 12 weeks for written consultation at least once.
 * 2) Be clear about what your proposals are, who may be affected, what questions are being asked, and the timescale.
 * 3) Ensure your consultation is clear, concise and widely accessible.
 * 4) Give feedback regarding the responses received and how the consultation process influenced policy.
 * 5) Monitor your department’s effectiveness at consultation.
 * 6) Ensure your consultation follows better regulation best practice.

The PCT’s proposals are not clear, concise nor widely accessible. Nor is it clear what the proposals are or who may be affected. The PCT singularly fails to communicate or give proper feedback.


 * Key questions:**

· Does the PCT have a clear consultation strategy; if so, what is it? · Is the PCT intending to consult patients of local GPs who may before making a decision or entering into agreements with GPs to re-locate to Hornsey Central? · How does the PCT intend to consult older people, disabled people, and people with learning disabilities about its primary care plans? · Will the PCT make a commitment to carrying out a full consultation with local people on the plans for Hornsey Central before making decisions or entering into agreements or contracts regarding services on the site? · Will be PCT make consultation proposals available in a range of languages and formats to ensure the information is fully accessible? What is the PCT’s understanding of meaningful consultation?

Linda Lennard September 2007