Above – the Old Addenbrookes from Britain From Above, as this post involves the hospital and its sisters. I had to write the Part 1 (See here) to give some historical and political context. This part looks at who could do what to improve our city (however you choose to define it)
This pair of blogpost came about from a number of things, but it was an interview that BBC Radio Cambridgeshire’s Louise Hulland had with a representatives from one of our hospitals that caught my ear.
The above related to the chronic staff shortages that the hospitals faced, and one case study where there had been a failure of care. If you’re a big hospital – and round this way Addenbrooke’s and surrounding institutions constitute a town within a city – one that various interests want to grow rapidly, there are a host of outside organisations you rely on.
I mentioned in the previous blogpost how their ability to provide excellent levels of care are dependent on the types of support they get from others over different time frames. Let’s take the problem of chronic staff shortages at our hospitals, and do a quick examination of how other institutions might respond to this.
In tabular form it might look like this.
|Addenbrooke’s Hospital||6-12 months||Five years||25 Years|
|Local/District Government||Discussions on future long term plans||co-creation of future plans/planning applications eg for key-worker housing close to places of employment||Inspection and sign-off of constructed buildings. Consolidation/improvement of sector|
|County/Regional Government||Identifying skills shortages||Develop and submission of plans for new training institutions & courses||Inspection, sign off, and evaluation of new institutions & courses. Consolidation/improvement of sector|
|National Government||Not messing up COVID||Development of new policies and funding for hospitals and linked public services||Continual monitoring, evaluation, shared learning, and support. Overhaul of structures, systems, processes & political philosophies of the state in face of global challenges?|
|Public transport providers||More bus services||More cycleways||Light Rail/metro|
|Voluntary Sector||Getting a baseline of what is already in place||Identifying what the major issues are and working through them in detail|
Above – an example table put together at midnight while recuperating from time in hospital: I.e. not at my sharpest!
Note I have not included individuals, neighbouring/local communities in the above table.
What I’ve identified are:
- District/borough level government: Housing – because town planning is in their legal competency
- County/regional level government: Adult skills – because that is in the process of being devolved to combined authorities
- National Government: Funding and legal freedoms/responsibilities – it is ministers who decide on the policies, and Parliament’s responsibility to scrutinise and approve both funding and legislation.
- Public transport providers: Buses – more services in the short term, easier-to-deliver infrastructure (eg cycleways) in the medium term, and the much more expensive but potentially society-changing infrastructure in the longer term
- Voluntary sector: Ultimately their impact will depend on the capacities, resources and willingness of the people around at the time.
If you were to run a similar exercise in a room with *lots* of people from diverse backgrounds you would end up with a list of far more interesting potential solutions than the one half-asleep me has come up with just now.
Greater Cambridge does not have the institutional structures on adult and lifelong education to deliver what our society needs
Whether hospitals, public transport workers, teachers and educators, you only have to look at the distances that so many of our fellow citizens have to travel to know that something is not right. Furthermore, attempts at consulting with the very people we want to help have been failing – as I found out the hard way while in hospital in December 2021. Mine was part of the feedback from many of you to the Combined Authority that should result in a better planned and more extended consultation starting after the local elections in May 2022 – see here.
During my civil service days when I commuted from Cambridge to London, I often wondered what the impact on Whitehall’s productivity would be if more of us civil servants could live closer to our places of work – so instead of the luxury apartments that seemed to be going up at the time, there would be at least some key-worker housing that would enable more of us to take a short walk to get to the workplace. It also made me wonder why several of the decision-making functions carried out by Whitehall were not simply transferred to local/regional government rather than having to have so much rubber-stamped by ministers. For example creating new lifelong learning colleges.
If we take the examples of Addenbrooke’s / Royal Papworth / The Rosie Maternity, soon to be joined by the Cambridge Children’s Hospital and the Cancer Research Hospital, then my medium and long term asks of fellow organisations regarding the Cambridge Biomedical Campus (and any nearby areas of land allocated for new development would include (but not be limited to) :
- Student halls of residents for medical, nursing, and allied health-related professions
- Key-worker housing for new members of staff at a stage of life or career where renting a property at a discounted rate close to their place of work would be better for them
- Council housing which could include accommodation for those with complex health needs, through to accommodating workers undertaking the essential non-specialist functions in what will likely to remain low paid in the current climate (eg cleaners and porters)
- Community and leisure facilities that can enable staff to have healthier lifestyles – but also ones that are large enough to incorporate local residents too. (eg. Overhaul the Frank Lee Centre and make it into a large swimming, spa, and leisure centre)
- The business and retail facilities (especially food) open 24/7 to match the shift patterns of the hospitals, which by their very nature are continually functioning.
- The public and active transport facilities that make it easy and reliable for staff and patients to use – including bus stops and cycle racks close to outpatients departments
- A lifelong learning centre for adults wanting to switch careers, to existing staff wanting to train up – making it easy for them to access both the work and training on the same site, and even better for them if they can be locally accommodated. (Note career-specific training institutions have been established before – in Cambridge’s case it was https://www.cambridgeast.org.uk/ – next to Long Road Sixth Form College. Both are superb institutions, but neither has a lifelong learning program of courses or similar institutions enabling local daytime provision.
- Cambridge Connect light rail underground – and at the same time working with the various local planning authorities to set aside land around each of the stops along the route for housing healthcare staff and students unable or unwilling to live in Cambridge City. The same could go for keyworkers in other parts of the public sector – and by that I mean people working in functions without which a city would struggle, if not cease to function without them.
“What are we not clear on?”
I’m not clear that the conversations between the institutions are actually happening at the moment. Furthermore, the reason for this is not necessarily the fault of the people within those institutions. A decade of austerity means that many of the public services have been firefighting – and that was before the Pandemic hit. So what hope do they have of sparing the individual members of staff to take time out of their day jobs to engage with their counterparts in other organisations?
It’s not just a funding issue either. There are structural problems that end up creating more work than necessary. Take the local government set up. The Greater Cambridge Shared Planning Service. A single function for both Cambridge City Council and Cambridgeshire County Council, their staff still have to attend two sets of meetings for two different sets of councillors on planning casework and approving local plan documents. This is something that could be resolved by an overhaul of local government across the country resulting in a single unitary council for Greater Cambridge (again, however you define it geographically) that incorporates allied functions currently sitting in separate organisations.
“If we were to apply the same process to the town planning function, what might it look like?
Again, we’ve known for a long time there has been a chronic shortage of qualified town planners – to the extent that the private sector snaps up any local authority town planner who show’s even the hint of competence and talent. And who can blame them if their salary is potentially trebled overnight in a city with such high living costs? So my asks might include (but not be limited to)
- New town planning Masters courses in Cambridge: Anglia Ruskin University has them at their Chelmsford Campus, but not in Cambridge. Please expand the course to Cambridge. Quickly!
- New lifelong learning centres (as recommended by the Commons Education Select Committee for every town in the country) delivering town planning modules for career switchers and also for interested local residents that can then be accredited by ARU for those that want the full qualification.
- The production of learning materials on town planning issues based on local case studies and actual materials, for schools, further education/extended project coursework, and university course modules.
- For national government to change the law and make town planning functions cost-covering to enable town planning authorities to compete with private sector salaries and employ the most talented town planners. This requires pressure from the general public on local political parties.
- Public education campaigns on the built environment – in particular ones that break the class-based attitudes about whose children ‘should’ go into which industries, which requires a massive long term culture change across society. Or as I think I put it ages ago on apprenticeships, ‘When we start hearing regularly that Etonians and privately-educated teenagers are turning down places as oxbridge for an apprenticeship instead, then we will have broken through!‘ But by that time all of the private schools might have been nationalised – which was a regular public policy debate throughout the 20th Century – and could well have happened had Clement Attlee’s Labour Party won the 1951 General Election.
Those are just a few examples of where local public service institutions face problems that are far outside of their legal competencies, and ones where they need to be in continual discussion with partner organisations. But given austerity and the challenges of our age, few have the spare staff and resource capacity to even begin thinking about this. Therefore the debate has to come from the grass roots – from all of us who need to raise these issues at a political level – and in election campaigns, so that come the next general election the main political parties have policies written into their manifestos before the campaigning starts.
Food for thought?
If you are interested in the longer term future of Cambridge, and on what happens at the local democracy meetings where decisions are made, feel free to: