Finsbury Health Centre

Emily Thornberry Excerpts

Wednesday 23rd June 2010 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Finsbury health centre in my constituency is a grade I-listed, purpose-built community health centre. The building is famous internationally and was the proud product of Finsbury's Labour council in the 1930s. It is a unique and ground-breaking building, and a real palace of the people.

Finsbury health centre is the product of modernist architecture and socialist reforming zeal. The council’s 1930s socialist leader, Alderman Harold Riley, had ambitions of urban revitalisation in Finsbury. The council wanted to build a comprehensive health centre amid public baths, libraries and nurseries. In the end, only the health centre was built.

Along with Chuni Lai Katial, chairman of the public health committee, Alderman Riley proposed plans for a health service that brought together the borough’s disparate services. In the 1930s in Finsbury, lice, rickets, and diphtheria were common, and most residents suffered from poor housing and atrocious, vitamin-deficient diets. Whooping cough and TB were widespread and responsible for thousands of deaths, only 10 years before the national health service was founded. However, in 1938 the council approached Tecton, whose lead architect was Lubetkin, and that was the first municipal commission of a modernist design.

Lubetkin was born in Georgia in 1901 and watched the 1917 revolution unfold while he studied art in Moscow. His attitude was:

“Nothing is too good for ordinary people”,

and he applied that to all his designs. In the Finsbury health centre he wanted to create

“a language of architectural forms, which, being firmly based on the aesthetics of our age, conveys the optimistic message of our time—the century of the common man.”

Lubetkin’s vision was that the health centre should be like a club. He wanted to encourage people to use its services by making them feel comfortable using them. They can just “drop in”, Lubetkin later said, and in the Finsbury health centre he created a light, bright, open building.

The entrance had red columns, azure ceilings and chocolate brown floors, and glass bricks and walls were used to bring a light, airy feel. It was designed to contrast with the gloom of the surrounding slums, and the glass walls sparkled in the sun. In a phrase that we might not hear modern men use when describing a building, Lubetkin said that it was to be

“as beautiful as the hair of a beautiful young girl in the summer sunshine.”

The building involved contributions from many who went on to be leaders in design and construction. The concrete structure was devised in collaboration with Ove Arup, a concrete engineer who was to work a lot with Tecton and went on to design and engineer other concrete icons, such as the Sydney opera house. The health centre has murals by Gordon Cullen. They were whitewashed during the second world war, but I hope that one day they will be restored to their former glory. Indeed, they are in good nick underneath the paint. The murals encouraged healthy living, with slogans such as:

“Live outdoors as much as you can”

and

“Fresh air night and day”.

The health centre was an oasis for the people of Finsbury, who mostly lived in small, dark and badly ventilated slum tenements. For all the talk of its design, however, we politicians appreciate the other way in which it was entirely revolutionary: it was financed by public funds—a precursor to the national health service.

When the centre opened, it incorporated a TB clinic, a foot clinic, a dental surgery and a solarium. It had facilities for cleaning and disinfecting bed clothes, a lecture theatre and a mortuary. Today, the centre brings together GP services and other health provision, everything from community dentistry to physiotherapy and services for stammering children. Indeed, I should declare an interest, because my family use the dentistry services of Dr Mysa at the centre.

Although the centre was a precursor to the NHS, it continues to show the way and is the model for the inner-London hub-and-spoke polyclinics that we now talk about. The centre was in fact the first polyclinic, and it would be a great shame to see all the lessons learned from that great building, which has been used over the past 70 years, simply thrown away.

Despite the health centre’s illustrious history, it is under threat. Although Islington primary care trust has worked for many years on plans to repair and improve the building, it decided two years ago to throw away the buildings and start again. It is almost impossible to find space in south Islington and Finsbury to co-locate that range of health services, and the plan seems to be to re-provide only GP premises; all other services will be dispersed to other venues.

There is talk of trying to find another health centre, but those of us who know the area believe that that is more of an aspiration than a reality. We have a potential polyclinic in our midst, and we are simply giving it away. That is a step in the wrong direction, and if the centre is closed, my constituents, rather than moving towards integrated health care, face losing a pioneering and excellent example of integrated health care in a fantastic, beautiful and unique building.

Finsbury health centre needs many urgent repairs. It needs a lift, for example. It also needs modern wiring, new plumbing, windows that close and working heating and ventilation systems, but a lot of investment has recently been made, including in roofing, concrete repairs and a new wing. Islington primary care trust argues that, by using its LIFT—local improvement finance trust——partner, it could refurbish the health centre, but that it would cost £400,000 a year more than building new GP premises on an adjoining site, and that that is more affordable. However, that estimate is based on a stage 1 costing exercise by the LIFT company, and it was not carried out by an expert in historic buildings.

A great deal of work has been done to advance the argument for keeping the health services at Finsbury health centre. In May 2007, I wrote to the PCT urging it to keep the health centre. In March 2008, I met the chief executive and the chair of the PCT confirming that I was opposed to the PCT’s plan to sell it off. In May 2008, I had a meeting with the PCT, English Heritage and the London borough of Islington to try to bring the parties together. In June 2008, I met the Heritage Lottery Fund to lobby for funding for the health centre.

In August 2008, I chased the PCT over an application to EC1 New Deal for Communities to see whether it would be possible to get money from the new deal to pay towards the health centre. It would seem that, although there had been a previous application to EC1 NDC for funding for Finsbury health centre, neither EC1’s board nor the PCT could locate the minutes. In September 2008, I met the PCT again and pushed the argument that we should keep the health centre open. In November 2008, I asked the PCT to provide full financial details and lobbied the then Secretary of State for Health to retain the health centre.

In January 2009, I wrote to the Secretary of State again, pressing for Finsbury health centre to continue to deliver health services to my constituents. Between January and June, the local health scrutiny committee referred Finsbury health centre to the Secretary of State, who then referred it to the independent reconfiguration panel, which then referred it back to Islington for local resolution. There has been no local resolution.

There were further inquiries by the health scrutiny committee, and I met EC1 NDC again to ask whether it could provide some capital to put towards Finsbury health centre. I also met the PCT to that end. The health scrutiny committee has been unable to reach agreement with the PCT. We therefore think that the matter is likely to be sent back to the Secretary of State. That is why I have applied for a debate now, in order to flag up this extremely important issue and to put the new Government on notice.

Last year, Islington council’s health and well-being scrutiny committee referred Finsbury health centre to the Secretary of State’s independent reconfiguration panel because the PCT had failed to consult the public properly about the centre’s future. The reconfiguration panel referred the decision back to Islington for local resolution, and as things stand the committee has been unable to reach agreement.

Will the Minister indicate whether he will retain the independent reconfiguration panel and explain the next steps if a decision is referred back to the Secretary of State? I am very concerned that NHS Islington is allowing the health centre to deteriorate while a decision is awaited. English Heritage recently met NHS Islington to discuss the need for urgent repairs to prevent deterioration having a serious and detrimental impact on the centre. Those of us who use it regularly can see it deteriorate before our eyes. Such deterioration will result in the costs of repair increasing even further.

My constituents feel very strongly about retaining the health centre. Members of the Save Finsbury Health Centre campaign, some of whom are here today, have attracted a great deal of support from Islington and beyond, including internationally, in their fight for the health centre. Last January, we presented a petition of 1,850 signatures to the Department of Health; it now has more than 2,100 signatures. The area surrounding Finsbury health centre is a significantly deprived one, and the patients it serves are among the most vulnerable of those in Islington. I am very concerned that patients who access existing services at the centre will not continue to do so if those services are relocated.

Islington council’s health and well-being committee recently issued a report on the future of Finsbury health centre. It found that 30% to 40% of patients access more than one service at the centre. That enables them to make appointments for treatment on the same day, meaning that they are able to visit the centre on one occasion rather than several. The committee’s 93-page report provides a detailed examination of the future of the health centre and raises a number of concerns and recommendations. It examines the assumptions behind the PCT’s cost estimates and calls for a proper feasibility study of the cost of refurbishment and for future maintenance of the buildings to be undertaken by a competent specialist.

The evidence that the committee received shows a wide discrepancy in cost estimates and opinions on fitness for purpose given by several witnesses and NHS Islington. I have to say that whenever I have met NHS Islington it seems to come up with a new figure as to how much this would cost. The committee also found that NHS Islington had failed to factor in the significant cost of disposing of the site.

The committee considered the question of funding and found that there are new avenues to explore. A charity specialising in the restoration of historic buildings, Heritage of London Trust Operations, told the committee that it was confident of attracting funding for restoration. English Heritage made it clear to the committee that the social history of the building as a health care centre was vital to the listing, and that the possibility of accessing funds was much greater if the building were in its original use.

Finsbury has already seen its magnificent town hall sold off for a pittance by the then Liberal Democrat council and we do not want another part of our precious heritage sold off for peanuts. Will the Minister give his assurance that Finsbury health centre will continue to provide health services to my constituents and that no agreement to close the centre will be given if the decision is referred to the Secretary of State again?

Finsbury health centre started 10 years before the NHS and showed the way as to how we should look after people, particularly the poor. It is a fantastic building and a fantastic political achievement, and the people of Finsbury are immensely proud of it. We should not lose it now. If the Minister has time, I would appreciate him coming to visit the health centre with me, where I will introduce him to my dentist.

[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.