Published: 03/06/2004, Volume II4, No. 5908 Page 12 13
The temperature is about to rise across north central London. In September the patch, which spans the strategic health authority's offices on Tottenham Court Road right up to the northernmost stretch of the M25, will be subject to two major consultations on changes to services.
And the services covered could not be more politically sensitive: children's and maternity. The proposals, originally due for release next month but now put back until September, will mean reducing the number of hospitals offering acute paediatrics and maternity services from six to four.
One of those reductions will come from Barnet and Chase Farm Hospitals trust in the north of the patch. The trust will simultaneously launch its own Healthy Hospitals consultation on a clinical strategy that includes consolidating paediatrics and maternity on one site.
The other change is likely to be more controversial: although no decision has yet been taken on which hospital will lose acute paediatrics and maternity, the geography of the patch raises the odds on a straight choice between the Royal Free and Whittington hospitals.
And with north London packed to the gills with Labour MPs - including a couple of marginal seats - consultation in the run-up to a general election over which local hospitals will lose acute children's and maternity services is bound to get interesting.
Political sensitivities are especially raw given that the loss of the traditionally Conservative seats of Hendon and Finchley to Labour in 1997 was widely attributed to the closure of Edgware General Hospital.
At the SHA, chief executive Christine Outram says, smiling: 'I think 'lose' is not a very helpful word. Wherever there were children's services in the past, they will still be there in the future.'
She is not alone in talking very positively - and convincingly - about the importance of developing ambulatory services and a network of children's services across the patch, as well as the need to respond to drivers like the European working-time directive.
The acute changes in the Healthy Start consultation build on radical changes to children's care across the SHA which are already under way. Haringey primary care trust chief executive David Sloman describes a four- way partnership linking specialist centre Great Ormond Street Hospital with the PCT and North Middlesex and Whittingon hospitals.
The reputation of children's services in Haringey was dealt a harsh blow by the report into the circumstances surrounding the death of Victoria Climbié in 2000. But Mr Sloman insists:
'This is not a response to Climbié, that would be unfair. If Climbié had never happened we would be doing this anyway.'
But Mr Sloman acknowledges that the PCT and other partners have gained from being able to share Great Ormond Street's reputation, particularly in terms of recruitment. Other benefits include integrated training, smoother care pathways and more access to specialist knowledge.
Mr Sloman is evangelical: 'We are aspiring to make the whole better than the sum of its parts.
This is the holy grail in terms of child services.'
Changes to children's services are just one of a host of issues facing north central London. Chief among them is public health, and more specifically health inequalities, rooted in a mobile population, and parts of the patch face high numbers of refugees and asylum seekers.
Figures are hard to come by, but the SHA says estimates suggest there are about 6,000 refugees and asylum seekers in Haringey alone.
It is currently at the epicentre of the largest outbreak of multidrugresistant TB in Europe, with over 100 cases. Meanwhile, Camden has the highest suicide rate for a local authority in England.
And even the apparently more affluent parts of the area disguise their own problems. Enfield PCT chief executive Sally Johnson says the A10, which slices through the middle of her patch, divides it neatly into areas of wealth in the west and poverty to the east.
Again, it is the deprived areas which have high numbers of asylum seekers and immigrants.
The PCT is struggling with key government indicators like those on smoking cessation, although Ms Johnson flags up as a success story a PCT-run clinic at the North Middlesex.
Teenage pregnancy is also an issue in Enfield. And Ms Johnson says: 'Last year's pregnancy statistics for teenagers show 30 per cent were asylum seekers. Many of them were pregnant as a result of rape in war zones. It is just heartrending stuff.'
Meanwhile, local acute trust Barnet and Chase Farm is facing up to some serious difficulties.
Chief executive Averil Dongworth - on secondment from Barnet PCT since February - admits: 'We have got a very serious financial position.'
She is currently embarking on a review of all the trust's activity to tackle financial problems, including an end-of-year deficit of just under£4m.
Meanwhile, Ms Dongworth admits that she 'wouldn't be surprised' if the trust loses its single star this summer, after struggling on accident and emergency targets during the star ratings measurement period. The glimmer of light on the horizon for Barnet and Chase Farm lies in its clinical strategy to rationalise services across its sites. The trust has also agreed an outline business case to develop an elective centre at Chase Farm - due to open in 2008-09 - which will expand capacity.
And when it comes to expansions, one trust is doing it with a vengeance. Right at the bottom of the patch, the eyecatching green towers of the new site for University College London Hospital have provided a new landmark for London's skyline.
The first - and largest - phase of the development is due to open next summer, bringing together four hospitals on one site. For chief executive Robert Naylor it is just the start. Now he is making plans to build a£30m ambulatory cancer centre, funded by charity.
But Mr Naylor admits that the trust is currently in a state of some uncertainty: with just weeks to go, UCLH is still waiting to hear if it will get the go-ahead for foundation status in July.
If it does not, the reasons are likely to be financial: 'We haven't got the best track record and clearly we are in a very turbulent financial period, ' he says.
He explains he is still concerned about how the payment by results policy will impact on teaching trusts, and about how far the trust's future finances can be judged during a period which will see double-running of the old and new sites next spring.
For Mr Naylor, one thing is crystal clear: 'This is a make or break year for the trust.'