The first time residents in the London Borough of Haringey felt that something was seriously amiss in the running of their health services was at a public meeting in February 2006. The PCT (primary care trust) announced its decision to sell the former nurses' home adjacent to the forlorn, and increasingly, dilapidated cottage hospital, which had been closed in 2001. The nurses' home, and an accompanying plot of land, had become surplus to requirements. The sale was being conducted as part of a public-private partnership to demolish the old hospital and redevelop the site.
There were about 30 people from the public at that meeting. I can't remember what prompted me to go or precisely the moment I realised that there was a darker message hidden in the hearty rhetoric. There was just something about the arrogant manner of those delivering the news and their carefully rehearsed, standard replies to questions from the floor that was alarming. After the meeting a few of us formed the Save Hornsey Central Hospital Campaign. Our aims were to restore the hospital to provide local, responsive healthcare to residents and continuing and respite care to older people.
Smug self satisfaction
Later that year, we attempted to mount a legal challenge to insist that the PCT consulted with residents about the sale of the nurses' home. It was intensely satisfying to see the PCT thrown off path and the smug self satisfaction fade from its board members' faces for a while. But its lawyers soon launched into action and in a long letter to our solicitors they listed the occasions that stakeholder and resident engagement had supposedly taken place.
In fact, the last time there had been any contact with the public had been 18 months previously. In the meantime, decisions were being made during the confidential part of PCT board meetings that were to change the face of healthcare in Haringey beyond recognition.
The former nurses' home was not the only thing being sold off. A local health clinic in Fortis Green, offering phlebotomy, podiatry, health visiting, baby weighing and speech and language therapy services, was also being closed. We discovered that the PCT had put this valuable building and land on the market. We protested. We wrote to the local council's overview and scrutiny committee and attended its hastily called meeting making heartfelt representations. But the closure and sale went ahead following a hurriedly published 'discussion document', which was circulated to local residents to stave off further legal action.
We were infuriated. The PCT knew that as long as it held the occasional, poorly advertised, public meeting, made presentations at area assemblies, sent huge, incomprehensible tomes to the patient and public involvement (PPI) network, issued press releases and responded to our letters and emails, it all counted as consultation. There was no requirement to show any interest in our views or to try to incorporate them into its plans.
Going through the motions
There is a legal requirement to go through the motions, however, which is why, early in 2007, a further, slightly different genre of public meeting was held by the PCT. This time it was to launch its forthcoming Developing World Class Healthcare in Haringey - A 10 year Strategy. About six months after the meeting, a questionnaire was distributed to up to 10,000 residents. There were just over 100 replies to this document - almost all of them, we know from a PCT insider, unsupportive. Submerged in this jargon-ridden and confusing missive was the most radical plan of all: the centralisation of all but 15 GP practices and the establishment of five polyclinics to cover the whole of Haringey - a borough that has one of the highest levels of deprivation and health inequality in the country.
Other campaign groups have formed around the borough as services and buildings have come under fire. Most recently, the PCT put out an invitation to tender for a GP service at the Laurels health centre. A strong campaign group formed and went along, together with members of our group, to the PCT board meeting late last autumn (2008) that would decide its fate. Their request for their deputation to be heard was refused and when the spokesperson for the Laurels Action Group remonstrated, members of the PCT board filed out sheepishly and reconvened in private in another room. When we followed and continued to insist on our right to be heard, the PCT called the police to eject us from the building.
Hornsey Central Hospital has now been demolished and in its place stands a shiny new neighbourhood health centre that will be leased back to the health service by the private company that built it. The tender process for the Laurels goes on unchecked.
It has been a frustrating, disappointing but also reaffirming struggle; our members and the very many residents we have come into contact with are committed to the NHS and we are unshakeable in our belief that a truly decent society depends on the extent to which we value and care for all members of the community. We are now the Better Local Healthcare campaign and our aims have widened to demand free, good quality local healthcare close to peoples' homes and to oppose the running down and privatisation of services. The campaign demands community engagement in healthcare and emphasises the need to be especially supportive of the most vulnerable members of the community.