HaNSAH is a recently formed group who came together- as a result of concerns about the plans to sell off two thirds of the St Ann’s Hospital site when there are so many unmet healthcare needs in Tottenham. We’re campaigning for improved and integrated, healthcare facilities that will meet the needs of people in Haringey now and for the foreseeable future.
In their promotional literature the BEHMHT consistently say that much of the site is surplus to requirements, but have never provided any data to back this up.
We oppose the sell of the NHS land that is currently held in trust for us by BEHMHT until it can be demonstrated through an objective healthcare needs assessment that the planned facilities are fit for purpose, will meet the current and future health needs of residents and that the overall impact of the redevelopment will reduce inequalities in health across the borough
Our group is made of up of local residents and health campaigners, many of us are also members of St Ann’s Community Reference Group (CRG), set up by BEHMHT to tick their community involvement box, but who became disillusioned at the lack of information provided to the CRG while asking us to comment, the lack of focus on healthcare issues and the lack of influence the CRG has had on the redevelopment plans.
Members of the CRG consistently asked for information about the use of health care facilities in the borough to inform the planning process. For example to share information on ill health incidence rates and where people currently had to go to obtain treatment.
No information was provided and in fact BEHMHT said they did not have this information.
This is alarming and unacceptable. How can a decision be taken that the site is surplus to needs if no proper assessment has been made of what those needs are?
Members of the CRG asked for the Director of Public Health (DPH) to come and explain how the JSNA was informing the redevelopment.
We were given her standard presentation on alcohol and obesity in the borough, we agree that these are important issues, but they do not relate to the St Ann’s redevelopment.
We asked for the public health team to undertake a needs assessment focused on the redevelopment. She refused!
We think members of the scrutiny committee should ask the DPH to conduct a needs assessment. With a development of this size and significance for the borough, and the planned disposal of designated healthcare land, the Council has a responsibility to ensure that the healthcare needs of residents will be met. The plans should also take into account the future needs of residents, including the anticipated substantial population increase if plans go ahead for an additional 10,000 homes in Tottenham. We would like to be involved in drawing up the terms of reference for the needs assessment.
The site was historically used for general healthcare and only relatively recently transferred to BEHMHT. If BEHMHT no longer need the whole site there are a range of general healthcare facilities which could be provided locally to improve local provision for residents who currently have to travel outside the borough for treatment, this could include a walk in minor injuries unit for example, which would relieve pressure on over subscribed GP services.
Members of the CRG asked for representatives from the Clinical Commissioning Group (CCG) to come and present their vision for the site, to date no one has come.
In fact in the entire public consultation process a CCG representative was present only once. It is possible that Andrew Wright had ‘discussions’ with the CCG but no detail was ever provided to the CRG.
We request that The Scrutiny Committee ask Andrew Wright to provide a report detailing what discussions have taken place with the CCG about meeting the healthcare needs of residents and increasing provision on the site.
As a result of this failure we’ve done our own research.
We believe the plans presented by AW do not even meet current needs let alone future needs.
We present information on the need for three specific services, though this list could be added to with more research:
- Mental Health Services
- Child Health Services
- Integrated Primary care and Urgent Care Centre
Mental Health Services
18 months ago Andrew Wright asserted that it was in the best interests of Haringey residents that all the mental health inpatient wards were moved to Chase Farm and none would remain at St Ann’s.
That assumption was challenged by service users from the MHSA and was tested twice in internal NHS reviews, both times the reviews found in favour of the service users and the decision to move the wards was changed.
About a year ago BEH MHT decided to close Haringey ward, we were told that it was surplus to requirements. As you will be aware, the CQC reported in August that seclusion rooms were inappropriately being used for patients because there were no beds available, this happened on 29 times in one month.
In their report to you BEHMHT said that in effect this was a ‘blip’, however before the CQC published their report one of our members got an email from one of the trusts directors, who said that ‘our wards are not overcrowded; they are however full and have remained so for quite some time.’
The JSNA states that Haringey has the third highest referrals for acute care in London. BEHMHT have reduced the number of beds from 50 down to a planned 36 in the new development.
The RCP recommendation is that wards should be operating at 85% capacity, its obvious that in Haringey we are well over 100%. We understand that BEHMHT frequently have to use private mental health beds because there are insufficient beds at St Ann’s.
Please ask Andrew Wright whether BEHMHT have met the CCG to discuss future capacity and what calculations they have done to ensure that the new wards meet the current and future needs?
Andrew Wright might tell you that they are working with the CCG to develop community and primary care mental health services, the JSNA says that 43% of acute admissions are people who are not registered with a GP and that most of them live on the east of the borough,
ask Andrew Wright how will improved primary care services help these people?
This is an issue of capacity it is also an issue of racial equality. The JSNA tells us People from BME communities are disproportionately represented in acute admissions. Failing to plan for these people would be unlawful discrimination
When questioned by the CRG about meeting future needs, BEHMHT said there is room for development in the future, he said they could always build upwards as the buildings were relatively low rise and there was green space around them.
But the inpatient wards are new build, they need to get it right first time! They can’t add another floor in a couple of years time, this would cause massive disruption…
As to the suggestion that they could build on the green space on the site, this would be counter productive and deprive patients of the well known therapeutic value of such spaces.
Child Health Services
If we were really thinking about future needs we would be thinking about our children’s health.
The Marmot indicator for child development in Haringey by the age of 5 is ‘significantly worse than the rest of England’, a year ago Haringey was the worst in England.
The SCR published following the death of Peter Connelly criticised local services it said:
- agencies were acting in isolation from one another without effective co-ordination,
- that there was poor gathering, recording and sharing of information
At this OSC in July last year Phil Watson and Dr Tony Wheeler from Whittington Health Child Health Services talked to you about the opportunities the redevelopment could provide for integrated child health services.
You said BEHMHT should consider the integration of the child development centre with CAMHS. Please ask Andrew Wright where and when BEHMHT considered this integration
In the ill fated Whittington Health Estates Strategy there was a proposal for an integrated child health service on the site, bringing together child health, child mental health and child protection services under one roof.
The proposal is led by clinicians and meets identified needs…
We wrote to Cllr Ann Walters about it she said, ‘In principal integrated services bring additional benefits to both users and the providers of services and I would therefore be in favour of the proposal . But the devil is in the detail and in these times finance is the biggest hurdle. There will need to be a lot of discussions before we have any clear idea what might be possible to co-locate and integrate on the site.’
We back to her asking what discussions had taken place and what the outcome was, to date we have had no response. If the issue is a current lack of finance, the site should not be sold off as this will prevent improved services when more money is available.
We ask members of the scrutiny committee to ask Cllr Waters what discussions have taken place and what the outcome was.
The issue is not really money it is the vision of integrated services. Services that work together with the welfare of the child at the centre
Integrated Primary care and Urgent Care Centre
At the first community involvement workshops there was a lot of support for an A&E department or Urgent Treatment Centre / minor injuries unit at St Ann’s.
We think there is a good case for an Urgent Treatment Centre on site given that there is currently no provision in the borough.
In March this year the Adult and Health Scrutiny committee heard a presentation on unscheduled care.
It was reported that in 2012 there were 10,212 residents contacted out of hours services. Of these 8,366 patients had a face to face appointment at a site. Of the 8,366 the following shows which bases Haringey residents visited:
5,306 at the Laurels
2,527 at the Whittington
259 at St Pancras
274 at Homerton
An Urgent Treatment Centre would take the pressure off local GPs in the area, and off the Whittington and N MIddx’s A&E departments., it would also mean residents did not have to travel so far to obtain treatment.
Last year the OSC asked a question about the integration of primary care services on the site, especially the Laurels. What was the outcome?
Before any decisions are taken on the future of the site it is vital that the Council and residents know the details below:
- What is the vision?
- Where are the integrated services?
- Where are the care pathways?
- How will patients benefit from this redevelopment?
- Will it reduce inequalities in health?
- Members of The scrutiny committee should should ask the DPH to conduct a needs assessment. With a development of this size and significance for the borough, and the planned disposal of designated healthcare land, the Council has a responsibility to ensure that the healthcare needs of residents will be met. The plans should also take into account the future needs of residents,
- Members of The scrutiny committee should ask Andrew Wright to provide a report detailing what discussions have taken place with the CCG about meeting the healthcare needs of residents and increasing provision on the site.
- Please ask Andrew Wright whether BEHMHT have met the CCG to discuss future capacity and what calculations they have done to ensure that the new wards meet the current and future needs?
- Last year you said BEHMHT should consider the integration of the child development centre with CAMHS. Please ask Andrew Wright where and when BEHMHT considered this integration and what the outcome was.
- Please ask Cllr Waters what discussions have taken place about the integration of local authority children’s services on the site and what the outcome was.
- Last year you asked a question about the integration of primary care services on the site, especially the Laurels. What was the outcome?
The HSCB (2012) introduced a duty for LAs, CCGs and HWBs to demonstrate how the JSNA has been used in planning and commissioning services
We are asking for the LA and CCG to abide by the law and ensure residents healthcare needs are met.
Haringey Needs St Ann’s Hospital