“A community-powered NHS” and the local public sector

Looking at what other things are needed to make the proposals from the New Local think tank work in practice.

You can read their report here.

My interest in this amongst other things is as a patient governor of the Cambridgeshire & Peterborough Foundation Trust, which is responsible for NHS mental health services in Cambridge as well as the rest of the county. And we need more people to sign up as members to help oversee the work of the trust. So if you or anyone else in Cambs or Peterborough is interested, please invite them!

The demand crisis

It’s not just the NHS. It could cover a myriad of issues, from consumption of goods, to our use of freshwater reserves to electricity use. Hence the concept and campaign Keep it in the ground re fossil fuels. (Which then makes the fossil fuel companies realise they are sitting on stranded assets they cannot utilise or profit from).

At school in the 1990s we were warned about the impact of an ageing society and the pressures it would put on societies. It was in A-level human geography and was something I covered again at university when studying economics. How do you deal with an ageing society that will inevitably require more resources put into health and social care? At this level, we were looking at the economic issues eg pensions and how they are funded, and the changes to our urban and civic infrastructure rather than the human aspects.

There have been a host of ill-health related issues that I don’t remember being mentioned in childhood or my teenage years. Dementia and mental health generally fall into that category. And it’s not just the UK that is struggling. A decade ago I became aware of how Germany was coping – by effectively ‘exporting’ some of its elderly into care homes in neighbouring countries in Eastern Europe, where financial costs were much lower.

“The German statutory health system covers only a fraction of the costs that elderly people face when having to rely on 24-hour care. For thousands, cheaper nursing homes in eastern Europe have become an alternative.”

From https://www.dw.com/en/eastern-european-nursing-homes-a-blessing-for-germans/a-16714130 2013

Sound familiar?

In the UK the model for decades has been to recruit staff from abroad to come to work in our health and social care systems. One of the results is me! Both my parents moved from Australia and Mauritius respectively to work at Addenbrooke’s in the 1960s.

“Ministers must take responsibility for their failures to ensure hospital beds keep up with population changes”

So I wrote last month when the census 2021 figures were released. Furthermore, only last week we saw another follow-up inspection by the Care Quality Commission stating both Addenbrooke’s and The Rosie Maternity Hospital required improvement in urgent and emergency care. When I read the report (you can read the CQC report here) I noticed barely any mention of the long term issues (housing and transport limitations) that had a major impact on the NHS Trusts’ ability to employ and recruit enough qualified staff. And that’s before we’ve looked at the Cost of Living Crisis – which is also hitting healthcare staff.

Reducing demand on healthcare by making it easier for more of us to live active lifestyles – while reducing the risks associated with getting out and about

Let’s have a look at this paper by Thomas Adams and Rachel Aldred from 2020 on cycling infrastructure in London.

Several of you will be familiar with Dr Aldred as she has spoken to audiences at CamCycle events in the past.

Above – Dr Rachel Aldred in June 2017 – speaking on Equity in Cycling to CamCycle at the Friends Meeting House on Jesus Lane, Cambridge

This was at a time when CamCycle started a major effort to diversify its membership and activist base, most of which I noticed at their meetings were 1) mainly older than me and 2) had longer beards than me too!

What Dr Aldred has to say matters – especially for public policy makers, highways engineers and urban designers. It’s not just about throwing down a few lines of paint on pre-existing roads.

“Paint is not infrastructure!”

I think it was Matt Boston of CamCycle who told me that one – one that I included in this short video for Living Streets Cambridge in support of their national campaign’s “Cut the Clutter” week.

Because if you want to get people out and about, having VOI e-scooters left all over the pavement, (as happens far too often – even though they make and install stands and racks that are already in place in other cities are available), are hazards. And it’s not like they haven’t been told by organisations and activists who know far more about these things than me – such as the RNIB.

“What’s this all got to do with community power?”

NHS organisations responsible for primary care (GPs and dentists) and secondary care (hospitals and specialist units) don’t have delivery responsibility for prevention. And by that I don’t mean sticking ‘warning’ posters everywhere, but rather improved urban design that doesn’t require remedial work or mitigation later on. E.g. digging up the road again for the former, or making everyone wear face-masks in traffic jams because the new road built is now full of fume-belching vehicles.

Furthermore, if one of their patients has chronic breathing problems or chronic sleeping problems caused by living alongside a busy main road, the solutions available to GPs don’t involve moving the patient to a different house, improving the noise insulation of the house, or taking radical action on massively reducing the level of traffic or the number of noisy and highly polluting vehicles on the road. All the GP can do is try and deal with the symptoms. They cannot solve the problems with the resources and powers they have.

Ministers repeatedly under-estimating the positive impact of local government support for the voluntary sector, and also the lifelong learning sector

The late Frank Dobson MP – who was my MP when I lived in London, stated the following to the minister then responsible for lifelong learning:

I find it hard to believe that this is being done by good and decent people such as my right hon. Friend the Secretary of State for Innovation, Universities and Skills. He is my friend and he is honourable, but he is not right; he is wrong on this occasion.”

Frank Dobson (Labour – Holborn and St. Pancras) in House of Commons, 08 Jan 2008

Above – from a blogpost titled Evening classes in a Big Society context – why have politicians undermined it? which I wrote on 09 Jan 2014. Progress update 2022? Back in 2008 I was part of a small string orchestra (viola – I know, hit me with the jokes from the first violins!) at the Mary Ward Centre in London – which was in Mr Dobson’s constituency. And it’s something that we should have in Cambridge but we don’t.

The Mary Ward Centre was one of the institutions that shaped my thinking around lifelong learning as a concept, and how institutions can support communities in overcoming a host of social problems through putting on a range of courses and activities that have the impact of bringing people together regularly over an extended period of time with similar or shared purposes. In fact, we used to be good at this stuff – to the extent we had a British Institute for Adult Education to represent the sector!

Today it’s known as the Learning and Work Institute – which I think sends out the wrong message. If the focus is on learning to get people into the workplace with an improved skills level, fine. But that does not cover all of the reasons why adults might want to get back into organised and/or group learning.

“If ministers don’t have a full knowledge of the roles of the institutions they are responsible for, what hope do the rest of us have?”

Quite. It remains to be seen whether the Chancellor remains in post and brings in such huge cuts to public services that are already on their knees.

“The greatest danger which faces democratic government in the modern world is that the peoples of the democracies themselves may not understand their own institutions. This has always been true, but today the problems of government are not only national, provincial, and municipal; they are international.

George W Brown in Canadian Democracy in Action, (1945) p4,

One of the biggest challenges in our current political and economic system is finding the people who have the time to commit to learning about, and understanding how our institutions function. Some of you may have spotted the Uber scandal that is engulfing the EU – and also stung the former PM David Cameron and his Chancellor George Osborne. Which puts the Licence application from Uber way back in 2017 – that someone asked me to film at the timein a very different perspective.

“Who has the time? And the expertise? And the desire?”

I come back to the Henley Centre’s research for the old DCLG and the Communities in Control White Paper of 2008.

What these proportions would look like (and whether they are the right categories) today for Cambridge I don’t know. What changes would you make? Especially in this supposedly post-lockdown age?

“How would the New Local model apply locally?”

Good question.

Looking closer at the pink boxes – which indicate a community-embedded model rather than a top-down state (teal) or a faux-market driven (purple) model, words like community, collaboration, place, local, all come up. None of those terms come up in the previous two models.

…Above – detail of the table from New Local at the start of this blogpost

How might this apply to somewhere like Cambridge, and where do some very strong assumptions kick in that need addressing?

Deep community engagement – Hard to do if your city has a high population turnover – and the 20% annual turnover of healthcare assistants at Addenbrooke’s speaks volumes. In 2014 Cambridge’s annual turnover was over 10% – one of the highest in the country. (Source – ONS). I have seen local campaign groups rise and fall as a result of hard working activists arriving & getting stuck in, and collapsing as a key driver of a group has moved onto pastures new.

Collaboration – Hard to do if one person or one organisation refuses. Something that the siloed nature of Whitehall departments, and ‘delivering to the contract’ of outsourced organisations sets in stone and is thus hard to break.

Place-based funding allocations – Hard to put in place because of the lack of geographical consistency of public service organisations and contractors. Cambridge City Council has different geographical boundaries to Cambridgeshire County Council which does not match the Combined Authority, which is different to Addenbrooke’s Hospital / Cambridge University Hospitals Trust, which functions at a completely different level to the East of England Ambulance Trust. And none of these match the boundaries of the Cambridge Council for Voluntary Services.

Local Accountability – one of the reasons why I’ve repeatedly called for unitary councils for Cambridge & the surrounding areas. Part of that challenge involves deciding how and where to draw the boundaries.

Community participation – part of that challenge is getting the right methods for the right consultations, co-ordinating the different consultations, and having a communications strategy in place that makes it easy for people to find out about local public services, and which ones they might want to get more involved with. At the moment, the pictures is far, far too complicated for a time-poor population even though on paper we are blessed with enough people with the skills and knowledge to make a good go of it. Furthermore, there are other national government barriers that ministers have thrown in for party-political reasons – such as removing the right to vote for EU citizens – something they chose even though there was nothing about leaving the EU that compelled them to do this. This was a political choice. Its impact? A much lower incentive for people without the vote to get involved. Scotland and Wales responded to this move by the Conservatives in Westminster by granting residency-based voting for local elections under their local powers that were part of their devolution settlements – local government in Scotland and Wales is a devolved matter.

These are not insurmountable problems – they can be overcome. Building a comprehensive active travel network of segregated cycleways to the campaigns for a light rail system for Gtr Cambridge and supported by Rail Future East Anglia and the Light Rail Transit Association (which currently has a special membership offer here, including student memberships for eligible under-25 year olds) are two indirect solutions that could give people with long commutes involving ages in traffic jams more time for other things. As well as improving people’s overall health by getting more fossil-fuelled motors off of the roads.

If we are to deliver something like this in and around Cambridge, it’s going to require the sort of vision (and the very high calibre of people to make it happen) that we’ve not seen since the days of Florence Ada Keynes and Clara Rackham in the run up to WWI and the interwar years.

But looking at some of the people who have gotten involved in local democracy, civic campaigning, community action and political activism both within and outside of party political circles, we might, just might be getting close to that point where we have that critical mass of high calibre people from diverse communities and interests who are prepared to put their differences aside and work for the common good of our city and beyond.

Not only could we achieve community-powered NHS in and around Cambridge, but also community-powered public services *and* the buildings & infrastructure from which they can work from and with. And if Cambridge is as wealthy as we are told it is, then there are more than a few people around who can match one of Cambridge’s greatest philanthropists – Sir David Robinson (below), benefactor of The Rosie Maternity Hospital in Cambridge (named after Rosie Robinson – his mother).

Above Sir David Robinson in the Cambridge Evening News via Mike Petty/Cambs Collection

He set the example for the rest of our city’s fortune-makers to follow – and did not restrict his philanthropy to Cambridge either – as the people of Bedford will be familiar with due to the Robinson Pools in their town.

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:

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