The call to shift services out of hospitals and build new centres in the community is not new: it dates back at least 34 years. JOHN LISTER has been looking back at the archives of earlier campaigns.
1992 – ‘Community Health Centres’
In 1992 a King’s Fund Commission report London Health Care 2010 argued that up to 15 major acute and specialist units should be replaced over the next 18 years by improved primary care and a £250 million network of Community Health Centres [equivalent to almost £700m today].
These were supposed to keep people out of hospital – reducing hospitalisation by a massive 25 per cent. It soon became clear that John Major’s Tory government would not give anything like £250 million for primary care, while one primary care manager openly derided the sum as ‘peanuts’, saying £1 billion would be needed to do the job.
Before closing down hospitals treating 250,000 patients a year in the capital, the least Londoners might expect is some pilot study to show whether the alternative arrangement is likely to work. However the King’ s Fund theory that adequate primary care would make acute hospitals redundant lacked any working examples to prove that it could succeed.
Nor did it factor in that Tory governments since 1979 had already systematically closed down almost every cottage and community hospital in London, and shown no inclination to invest heavily in constructing any new network to replace them.
In October 1992 came the report from Sir Bernard Tomlinson, the retired north-of-England pathologist who had been appointed in 1991 by then Health Secretary William Waldegrave to plan a wholesale reduction in London’s hospital capacity.
It proposed closing ten London hospitals, including four teaching hospitals, despite Tomlinson having been warned in advance that there would be no extra government cash for improved primary care – which the report insisted was required before hospitals and beds could be closed.
Both the Kings Fund Commission and Tomlinson reports were deeply flawed, reflecting an ignorance of London’s health care system and its population, especially outer London, where two-thirds of the capital live. Neither proved politically or practically possible to implement as proposed, especially given the tight financial limits.
2007 – Polyclinics come and go
In the summer of 2008 31 London Primary Care Trusts (antecedents of today’s much larger ICBs) voted to press ahead with a scheme to build new ‘polyclinics’ and close hospitals, a plan which virtually nobody in London actually supported.
Professor Sir Ara (later Lord) Darzi’s 2007 report calling for family doctor and other services in London (and elsewhere) to be centralised into a new network of polyclinics had triggered confusion, debate, opposition, and a massive campaign by the British Medical Association to “Support NHS General Practice,” and save local GP surgeries, which secured a million-strong petition.
Critics pointed to serious flaws in Darzi’s “technical document” which tried to show how the polyclinics would work.
Darzi’s report suggested a network of 150 polyclinics to cover the capital, each to cover a local population of 50,000 and employing 100 or more staff including upwards of 20 GPs and many more nurses and support staff at an estimated cost of £21m a year for each polyclinic. Each polyclinic would need a substantial building with 43 consulting rooms and space for the direct provision of other services, although Darzi later retreated from this, saying that services could be spread over various buildings.
Despite strong opposition from the BMA and major reservations among Strategic Health Authority bosses, a consultation based on Darzi’s plans was held – a lavishly funded £1m ‘listening’ exercise, in which Darzi and his supporters claimed to have ‘engaged’ with over 60,000 people in set-piece review events around England.
The results in London, drawn up by spin doctors Ipsos Mori, claimed a wafer thin 51% of responses supporting the idea of polyclinics. But on closer examination, the 51% turned out to be fewer than 1,900 people (technically a majority, but out of just 3,700 who responded to the consultation) – from a London electorate of 5.6 million.
In other words, Darzi’s plan was supported by just 0.03% of adult Londoners – hardly a resounding mandate for a risky and controversial policy.
Nonetheless, PCTs began to draw up plans to force over 100 GP surgeries around London to close to make way for polyclinics – including Haringey, Enfield, Ealing, Kensington & Chelsea, Camden, Lambeth and Waltham Forest.
Outside the capital, campaigners also challenged similar plans in Norwich, South Staffordshire, Bolton, Cheshire, Greater Manchester, pointing to evidence that the existing model of GP practices offers more choice, better access, and greater quality of care than polyclinics.
To make matters worse, the plans for polyclinics were also linked to the New Labour government’s plans to wheel in major corporations to fund, build, and run them. Big corporations were also looking for contracts to deliver primary care services.
Eventually, the combination of unaffordable costs, resistance from GPs, the lack of popular support for the plans – and of course the 2008 banking crash – diverted government energies away.
Darzi himself began to water down his own proposals, and the word ‘polyclinic’ was quietly abandoned. Now the same idea, already diluted from the plans for such large single site units, is being wheeled out once again under the label of Neighbourhood Health Centres in Labour’s Ten Year Plan, indicating that ministers have learned nothing and forgotten nothing from the failures of the past.
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