The Minister of State, Department of Health (Mr Paul Burstow)
I congratulate the hon. Member for Islington South and Finsbury (Emily Thornberry) on securing this debate on an issue that is clearly very important to her and many of her constituents, who have campaigned for many years. I thank her for taking the time for this debate, not least because it has educated me about some initiatives that were taken prior to the foundation of the NHS. Some of those were clearly inspirational and influential in shaping the ideas that informed the foundation of the NHS.
Earlier today, I had a look at the plans, so I saw for myself just what a huge beacon of hope a building of that sort would have been in the 1930s in the area that the hon. Lady describes. I understand the strong feelings that she has expressed and the powerful case she makes.
The hon. Lady asks for an assurance on the building. I will amplify the reasons for this in a moment, but such an assurance would prejudge the process, which I am sure she would not expect me to do in the House tonight. However, I want to be as helpful as possible. In setting out the case tonight, she rehearsed some of the important history—it goes back more than 70 years. Having seen the pictures and the plans, I share her view of the significance of the building, which clearly goes beyond the boundaries of the London borough of Islington.
The building’s design was ahead of its time. I am told that the centre was the first of its kind, and the hon. Lady outlined the many services that the centre has provided over the years. It was indeed a visionary endeavour.
Emily Thornberry
The point is that it was the first publicly funded health centre in the country. Although it was primarily funded by a local authority, that local authority showed the way to a future national Government.
Mr Burstow
Such initiative on the part of local authorities is perhaps something that we should applaud and learn more from for the future even today.
When I was preparing for the debate, it was drawn to my attention that the architect of the centre, Lubetkin, was involved in the design of the penguin pool at London zoo. I have had the pleasure of visiting London zoo with my children, so I recognise the range and scope of his designs. As the hon. Lady said, when the Finsbury health centre was opened in 1938, Lubetkin remarked:
“Nothing is too good for ordinary people”.
He was quite right too. The notion of the health centre as a palace of the people is important.
Lubetkin was ahead of his time, but that motto resonates today, because all NHS staff, not just those at the Finsbury health centre, take it to heart and practise it every day. They have played, and continue to play, an essential role in improving health within the London borough of Islington and elsewhere, and I can understand why the centre is viewed with such affection and passion by local residents, and why this matter has aroused such strong feeling.
I need, however, to rehearse some pros and cons. I understand that the future of the Finsbury health centre has been under discussion and debate for at least 20 years, and that more recently Councillor Martin Clute, the chair of the Islington overview and scrutiny committee, has played an important role in leading the debate about the relevant priorities. I am also told that the primary care trust and Islington council’s health and well-being review committee are continuing to find ways forward and to discuss this matter.
There are strong arguments on both sides, many of which the hon. Lady has rehearsed. For instance, we have to consider the view that what was state of the art 70 years ago may not be well suited to the demands and delivery of 21st-century health care. The PCT has told me, in briefings I have received, that there are real limitations to the centre in its current form. For instance, there are problems meeting statutory requirements on disabled access. In addition, reception and other patient areas are badly laid out and cramped, and the centre is in a poor state of general repair. Criticism could be levelled at the PCT for failing to make those investments, but nevertheless those problems remain. I am also told that it is proving difficult for the centre to provide patients with dignity and privacy, about which we should all be concerned. The hon. Lady has already told us about the status of the building. It is a grade I listed building, which inevitably places additional restrictions on what work can be done to rectify the problems I have identified.
On the other hand, the local health and well-being review committee has published a report questioning the PCT’s conclusions and has raised important concerns about access to health care for some of the most vulnerable groups in Islington.
Emily Thornberry
Lubetkin designed the building with the idea of flexibility in mind, as was highlighted to the PCT and Islington council when I was having discussions with English Heritage. Although it is a grade I listed building, there is a huge amount of good will in terms of what can be moved and how things can be changed within the building, because everyone wants, if possible, for the building not to be mothballed, but to continue to be a living, breathing building.
Mr Burstow
I hope we can find a way to preserve it as a living, breathing building and a testament to its history.
Finsbury health centre could be modernised, as the health and well-being review committee has said. The hon. Lady’s point about the co-location of services was made in the representations from the overview and scrutiny committee. However, the PCT would say that considerable financial costs are associated with that. It has estimated that the capital costs of £9.1 million to refurbish the health centre could translate into about £1 million a year over 25 years. By contrast, it says that the PCT could provide a new building somewhere else in the area and that the rent for that would be £600,000 per annum. On that basis, the NHS asserts that it would be paying a premium of £400,000 per year to keep the Finsbury health centre open.
I understand the trust has pursued various sources to fund the refurbishment, including the Heritage Lottery Fund, but these have not been available due to the eligibility criteria used. With this in mind, clearly there is an important issue that needs scrutinising about the costs and benefits of keeping the health centre open. Would that money be better spent on providing services to local people elsewhere rather than in the existing building? There is an opportunity cost here—contested perhaps, but a cost none the less.
On the Islington new deal committee, I understand that representations were made, about which the hon. Lady has talked, but I gather that they were rejected last December by the committee and the moneys not made available. However, I think that I can give her some hope in respect of announcements that the Government made a few weeks ago on the principles that we see being critical to how we reconfigure services in the future. That is clearly relevant to this controversial issue, because it is important that neither I nor the Secretary of State should be taking sides in the debate that is taking place locally. It is important that the matter is resolved locally and, only if it cannot be, that Ministers then become involved.
The issue should be resolved by the PCT and the local health and well-being review committee working with patient groups, clinicians and, more generally, the local authority to reach an acceptable solution. I recognise that change in the NHS has always been a problem, in terms of how it is handled locally. It has certainly been an issue in the past—I have seen that in my own constituency—and that is often why decisions have provoked the deep concerns and anxieties that the hon. Lady has described this evening. That is why the Government are determined to do things differently, in a way that gives MPs, the public and particularly clinicians the opportunity to shape the decision-making process. That is why the Government have already announced an immediate moratorium on all pending service changes. Indeed, we have required NHS London to look again at the entire Healthcare for London strategy.
The Secretary of State for Health has set out four crucial tests that all future service changes must now pass. First, they must have the support of GP commissioners. Secondly, arrangements for public and patient engagement, including local authorities, must be strengthened. Thirdly, there must be greater clarity about the clinical evidence used to underpin any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice. The whole point is to ensure that all decisions that affect local communities are taken by local communities, with particular reference to what clinicians think is the best solution, based on robust clinical evidence. The point that the hon. Lady made about co-location needs to be considered in that regard.
What does all that mean for Finsbury health centre? It means inviting patients, GPs, clinicians and the local council to play a fuller role in deciding what should happen next, sharing responsibility for deciding on the best way to secure those important services. I understand that further local discussions are taking place between the PCT and the health and well-being review committee about its report and how the PCT will respond to it, which it will within the next few weeks. I stress that it is vital that the PCT and the local health and well-being review committee continue to work together with local groups to find a resolution to the problem. However, the PCT tells me that it is in the process of reviewing its plans against the criteria that the Secretary of State has set out. I would urge the hon. Lady to engage with and challenge the PCT to ensure that it is doing just that.
It is particularly important that the PCT works with local GPs and commissioners. Furthermore, it is not just the overview and scrutiny committee that needs to take a view; the whole of the London borough of Islington council needs to form a view as well. I strongly believe that it is in everybody’s interest that the issue is resolved quickly. It has been going on for far too long, and I understand the hon. Lady’s frustrations. What we need is a resolution that addresses those concerns in the way suggested by the Secretary of State to look at reconfigurations.
I hope that a swift resolution is possible, but there is always the possibility that the local health and well-being review committee will still consider the outcome unacceptable and refer it to the Secretary of State. The hon. Lady asked me how that would be dealt with by the Department. The answer is that there will continue to be an independent process of reconfiguration review to offer the Secretary of State advice in undertaking his arbitration and decision-making responsibilities at that final stage.
I recognise that these are difficult decisions, and they quite rightly provoke debate and discussion—and, in this case, disagreement. I am afraid that not all decisions can be made here in Whitehall or Westminster by Ministers, and we certainly should not seek to dictate. However, what is important to me as a Minister is the integrity of the decision-making process. By seeking the support of GPs and local people, basing decisions on clear evidence, and ensuring that all changes improve patient choice, we believe that we can achieve a better health care system for the people of Islington—one that is affordable and cost-effective. That is what I now expect from NHS Islington.
The hon. Lady will continue to play an important part in that, ensuring that all the sources of funding are understood and can be brought to bear. I hope that she will engage with the PCT and the local authority to get the long-term solution that delivers health care that is fit for purpose and is what local people want.
Question put and agreed to.