A&E: it’s about more than one bureaucrat’s opinion

Published: 9 April, 2010

• AS anger, indignation and disbelief rumble on over the proposed closure of the A&E at Whittington Hospital, the question everyone is asking is: how can one person hold the fate of the Whittington in her hands, when everyone except a handful of NHS bureaucrats believes this is a completely wrong-headed thing to do? Most people in Islington like to think they live in a democracy, and yet this situation seems to be fundamentally undemocratic.
I am chair of Islington Council’s health scrutiny committee. In order to get the chief executive to appear at the recent committee meeting to speak about the Whittington proposals I had to invoke the committee’s rights under health legislation to insist she turned up. I had to point out to her that the legislation says she should have approached us months ago to discuss her ideas, when her plans were at “an early and formative stage”.
As it turned out, her presentation was entirely about arguments for closing the A&E, and there was no sense of balance or of options or alternatives in any of the comments she made. The final page of her presentation, which was rather unfortunately titled “closing remarks”, included only a list of justifications for closing the A&E, and that was all. We have some serious work to do to convince this woman that her view is not the only one that matters, and that it might even be wrong.
The Whittington issue is only one of several that have convinced me there is a chronic lack of accountability and transparency in the way NHS Islington takes important decisions about service provision.
Significant numbers of the public have been attending the committee meetings, and I hope they will agree that I have started a process, by using the powers of the committee, to re-establish a level of accountability for health services in Islington. 
I have shown this not only by challenging robustly the proposals to close Finsbury Health Centre, but also by calling in each of the trusts that provide Islington health services to address the committee and take questions. This has given the public a chance to ask questions and put their points of view to administrators.
CLLR MARTIN KLUTE
Labour, St Peter’s Ward

• TOM Foot was far too kind to Rachel Tyndall (Woman who has A&E fate in her hands, April 2). The statistics she showed at the health scrutiny meeting largely didn’t even relate to hospitals in Islington and Camden, much less the Whittington itself; there was also nothing pertaining to just how the new polyclinics (or “polysystems” as she insisted) are going to absorb all the A&E patients. Certainly, no figures were given for how much her “vision” of the new “care pathways” will cost to set up.
We saw the same sleight of hand over the decision to close Finsbury Health Centre. Now that the recent council investigation has dragged out the relevant facts, the primary care trust board has finally agreed to reconsider, and we hope for a more clear-headed and informed decision in May. All candidates should sign up to supporting the last council’s recommendations to keep the health centre open, which are based on evidence and not “visions”.
The problem, however, is not so much Ms Tyndall, but the system of locally unaccountable, secretive quangos running the NHS, which gives her and other NHS bureaucrats so much power to promote these “visions”. Locally, the quangos are proliferating: not only the new North Central London Sector Trust, but a Children’s Trust and a joint Haringey-Islington Provider Trust have also been recently announced, at further management cost to the NHS.
All this disruption and uncertainty over what Ms Tyndall claimed are cuts necessary because NHS London may not get a rise for inflation in the next few years. Maybe if she and her fellow executives gave back the average 40 per cent increase in pay they took last year, and NHS London stopped sprouting new quangos, a similar savings could be found. We can certainly no longer afford more blinkered visionaries.
BARB JACOBSON
Campaign to save Finsbury Health Centre
www.savefhc.org.uk

• YOUR report made depressing reading. Not so much for the bad news – we already know that – but because Rachel Tyndall exemplifies the smug indifference to public opinion which is so typical of the modern bureaucrat. She is not going to listen to us, or our councillors, let alone the Whittington’s consultants.
She would appear to be saying we must lose our A&E and maternity services at the Whittington because of looming cuts. The intent here is to make us believe this is all down to the budget deficit.
When I had to go to A&E in the middle of the night some seven years ago, the total NHS budget was £65billion, today it is £105billion. Even allowing for inflation, we should still be able to afford what we could afford seven years ago. That is, if executives have been doing their job properly by controlling costs and increasing productivity.
Efficiency savings there may have to be but I believe the profile of the proposed cuts has more to do with outsourcing our NHS. How much extra will we have to pay for private finance initiative schemes? Does the polyclinics policy mean we also face losing our GP surgeries?
How much control over our health policy is in the hands of McKinsey, the American consultancy firm, to the benefit of faceless healthcare corporations? Is now the time to catch up on home-dentistry?
 The policy has already been set. The decisions have already been taken. That is why we don’t hear about alternatives.
It’s the same story at Finsbury Health Centre. What remains is to try and sell the “unpalatable” policy to an angry public. This is an executive which thinks toughing it out is the right approach to the wrong policy.
RICHARD ROSSER
Highbury New Park, N5

• GOOD health is of prime importance. Therefore, when political parties come knocking, asking for your vote, tell them you don’t want any more cutbacks in medical services in what remains of the NHS. Ask them where in their leaflets they have defended local NHS care. If you are unsatisfied or unhappy with their reply, send them away with a flea in their ear.
Voters have a right to demand that essential, front-line services are not totally eroded by commercial interests. The last thing the public needs are groups of middle men grasping our hard-earned taxes and determining what can be spent on our health care.
Tell politicians to stop the sale of Finsbury Health Centre. It is a building ready for expansion of services. Only a spurious case has been made for its closure. To learn more about the centre, go to www.savefhc.org.uk.
ANDREW DA SILVA
Percival Street, EC1