Suspension (and re-opening) of the LUTS (Lower Urinary Tract Symptoms) clinic.

As the Chair of Islington’s Health and Care Scrutiny Committee, and Vice-Chair of the North Central London Joint Overview Health Scrutiny Committee - JOHSC (which covers Barnet, Enfield, Haringey, Camden and Islington), I first became aware in early November of patient concerns about the possibility of closure/decommissioning of a specialist LUTS clinic, which is run by Professor James Malone-Lee from a medical centre in Hornsey, and commissioned by Whittington Health.  Anxious patients asked to attend the December meeting of the JOHSC to make a deputation to the committee to express their concerns.  It seems that professor Malone-Lee has been using a regime of prescribing higher strength, longer-term antibiotic treatments than is usually considered acceptable under NICE prescribing guidelines to treat the patients' symptoms. The key point in all this is that the patients have all tried many times (and failed) to get their symptoms cured under more conventional treatment regimes, and had been referred to Professor Malone-Lee’s clinic as a last resort. Many of the patients report that this regime has worked for them where all others had failed.

We were in the process of organising to take the deputation when I received a phone call from Simon Pleydell, Chief Executive of the Whittington, telling me that they had taken an urgent decision to suspend the clinic following two episodes of related patient harm.  The Whittington said they would be making alternative arrangements for patients, but this didn’t seem to transpire.

As soon as the announcement was made, I started receiving long, anxious emails from patients, all of whom wanted to talk quite candidly, and in some detail, about their symptoms, and to relate how the professor’s treatment had been the difference between a life of almost unbearable discomfort, and a semblance of normality.  I personally received over 50 emails from patients of the clinic, all surprisingly detailed, and with a very similar story, and ending with the distress and anxiety they were all suffering at the prospect of not having their prescriptions renewed, and a return to their suffering.

What followed was a combination of intense lobbying of the Whittington, and myself, and also Cllr Alison Kelly (Camden) Chair of the JOHSC.and Cllr Pippa Connor (Haringey) vice chair, by a very determined group of patients.  I had a number of conversations with the Whittington during which I suggested that, given the patients’ clear understanding of the risks of the treatment, and that they considered this risk worth taking, that the clinic should be re-opened on the basis of an agreement with patients about the risks, perhaps some kind of disclaimer similar to that used with cancer patients.

The Whittington then held a meeting with patients, whilst at the same time a group of patients took the issue of the closure to court.  The Whittington seemed generally chastened and surprised by the strength of feeling, and the loyalty of patients to the clinic.  Shortly afterwards, an agreement was reached with Prof Malone-Lee to a lesser restriction on his prescribing and for a full independent review of the clinic and it’s practices to be carried out, following which the clinic was re-opened.

About a week later the JOHSC took the deputation, and after about an hour’s debate, we arrived at a series of recommendations to ensure that the independent review of the clinic is properly carried out, and that patients would be protected meanwhile.  The recommendations, as agreed by the committee are as follows:

Recommendations:

1.    That the Committee be minded to consider any proposal to decommission the LUTS Clinic by local CCGs as a substantial variation to services and that the issue be referred to the Secretary of State should such a proposal proceed without comprehensive consultation on the grounds of failure to consult.  

2.     That the committee be given the terms of reference for the external review of the LUTS clinic, that the terms of reference of the review should include the Whittington’s actions leading up to the suspension of the service,  and that the results and recommendations of the review be presented to a future meeting of the committee prior to any further decisions being taken to decommission. 

3.     That the Committee be updated with the Strategic Risk Register from Whittington Hospital and that the communications and engagements strategies and responsive action plans are shared with the Committee, to satisfy the committee that appropriate arrangements are in place should similar circumstances occur in respect of any future urgent actions by the Whittington.

4.     “That letters be sent to both Haringey and Islington CCGs requesting confirmation that they will not be proceeding with their proposed decommissioning of the LUTS Clinic pending the outcome of the Independent Review.” 

Actions:

In relation to the level of treatment and the prescriptions that were carried out at LUTs Clinic, Councillor Pippa Connor, requested that the Committee receive an update on whether any medical studies or reviews were undertaken by UCL about the treatment provided to patients.

I appreciate this is a very abbreviated version of events, which excludes a number of details.  However, I think the most important issue is to get the committee’s recommendations published as soon as possible, since with regard to protecting patients’ health, the recommendations are aimed at protecting them in the short-term as well as the long-term, and I want patients to have the recommendations to hand, should discussions arise with either the Whittington, Prof Malone-Lee or UCLH, with whom the Prof carries out his research. 

The Sun always shines on The Angel Canal Festival

Vivien, Lloyd, myself, Graham and Muhammad on the Labour
Party stall.

Myself, deputy Mayor Kat Fletcher, Youth Council member Zen,
and Brian Voakes, chair of the Angel Canal Boat Trust on our
way to the Festival.

Once again the canal festival had the luck of the gods.  The sun was peaking through at 9 o'clock, and by 4 in the afternoon was baking hot, and the Festival was heaving with people.

I had a particularly good start to the day having been invited to join the Deputy Mayor for a VIP trip from the Canal Museum, through the Islington Tunnel to City Road Lock for the opening ceremony of the festival, and then on to Islington Boat Club for some races.  It was great to meet Brian Voakes, the Chair of the Canal Boat Trust, and hear about the work they do with taking deprived children on 5-day canal adventures on the Angel 2 boat, and the team-building and environmental awareness this gives to the children.  And also, to hear about their expanding work with early dementia patients, who they help to stimulate with drawing, singing, and opera singers in the tunnel!

We arrived at City Road lock and Kat Fletcher gave an excellent welcoming speech, making particular reference to Crystal Hale, who started the Trust, and who successfully campaigned to prevent City Road Basin being filled in and built on.  -  It seems unthinkable now.

Moving on to our stall on Danbury Street Bridge, we collected over 300 signatures to our petition against government plans to force the sell-off of 'high value' council properties when they become vacant (most of the council homes in Islington will meet the governments proposed threshold market value of £400,000 and would have to be sold).  This hideous policy would drastically reduce the amount of social housing available in Islington, and eventually, remove it completely, resulting in draconian social cleansing in the area.  Generally it took less than two minutes talking to people to convince them that this is a completely unacceptable policy.

We also had some useful conversations with residents on other topics, such as the current consultation on changes to the CPZ rules.  Most local residents are either against or sceptical, and even John Ackers from ICAG broadly agreed with my position.  We also talked about other housing issues, air pollution on the canal, antisocial behaviour, phone thefts, more general discussions about the London housing crisis, and the vulgarity and inappropriateness of the tower blocks going up at the City Road end of the City Road Basin.

It was a great day, we met people from many of the strands of our community, and it made me feel really good to be a ward councillor in St Peters.

Has the Council got the parking wrong? - Clarification

Since I first published my blog about the current CPZ consultation I have been lobbied by a diverse group of interested parties, including local businesses, residents, charities, and environmental campaigners. The following hopefully clarifies the approach I am taking on this issue:

My current position is based on views put to me by constituents and other interested parties, including local businesses, on whose behalf I am trying to raise the level of debate, focussing on whether the proposals make sense, and whether, if implemented, they might have different outcomes to those suggested by the consultation. The consultation documents suggest, for example,  that the proposals will make it easier for residents to park.  It has been put to me that they may not, and that they may also have a harmful impact on local businesses, markets, local charities, and the wellbeing of older and more infirm people who rely on visits from others, often made by car, and for whom the new visitor arrangements could well be sufficiently complex to discourage visitors.  

It is a complex enough discussion to try and establish if the outcomes of the proposals will be as intended, especially given that there seems to be very little empirical evidence to support them.

If we start trying to debate the wider issues, such as the merits or demerits of parking controls in terms of the impact on the environment, whether these controls might encourage or discourage car use, whether controls are intended to reduce car usage or simply regulate parking, whether they make the environment safer or not, and whether we can afford to assume that all private car use is inherently bad and should be discouraged, the debate will unravel completely, which is why I am not attempting to address any of these points.  

For the moment, I am simply reflecting and representing what seem to me reasonable and reasoned views that have been put to me regarding the current consultation, as any Councillor should.  

Has the Council got the parking wrong?

Islington Council is currently consulting on changes (ie extensions) to the Controlled Parking Zones (CPZ) in five areas of the Borough.  The Council is arguing that in the case of the Arsenal matchday zone, the changes will eliminate confusion about which days there are restrictions in place, and in the case of zone 'B', that it will make it easier for residents to park in the evenings.

I have been contacted by a number of residents and businesses with comments about the proposed changes which make me think that the changes may not have the intended outcomes.

In the Matchday and zone B areas, residents say that at the moment, if they arrive home in the evening and there are no resident's spaces, they can simply park on a yellow line nearby, and then move their car to a space in the morning, which works quite well. With the proposed changes, residents would be forced to find a free resident's bay, which could involve a significant amount of driving around looking for a space, or  risk getting a parking ticket.  Also, in zone B, where the proposed hours would be different to the adjoining zones, there would be a greatly increased chance of residents accidentally getting a ticket for parking in a Zone B street after 6.30, or on Saturday afternoons and Sundays, which introduces a similar type of confusion to that which the proposals are trying to remove in the matchday zone.

Local businesses are also extremely concerned about potential harm to trade of the zone B restrictions, since it would oblige all customers visiting the area to find a legal space or get a parking ticket, as single yellow lines would be out of bounds. The Council says that the charge to park in a parking space would be only £2.40, but this doesn't take into account the hassle of trying to find a legal space, which risks putting a lot of people off coming to the area.  Also, particularly worrying is the possibility that both traders and customers of the Sunday Farmer's Market in Chapel market will be driven away by both the cost of parking and not being able to legally park near enough to the market to make trading or shopping viable. Some residents and businesses have also expressed doubt about the motive for holding the consultation over the summer holiday period, and have also questioned whether there is any empirical basis for the proposals, rather than just one person's view against another's over whether the impacts will be positive or negative.

It seems to me quite possible that these proposals would make it harder for residents to park, increase the likelihood of accidental parking tickets, and also damage local businesses, including the real possibility of killing off the Farmers Market, none of which would benefit local residents.

I would urge as many residents as possible to respond to the consultation before it ends on 7th September.   (Google - 'Islington Parking Consultation')

Is the 'Mansion tax' a good idea?

Firstly, the name is wrong.  (It was the Lib Dems’ name before Labour got hold of it.)  The word ‘mansion’ in this context is a pejorative term, smacking of the envy of ‘rich’ people.  A divisive ‘them and us’ attitude, which is not a sound basis for introducing a new tax, especially not a tax from a socialist party that is supposed to treat all as equals.

But if we get beyond the name, we need to be sure what we think it is intended to achieve:  

I am very concerned that a tax based on the current 'value' of properties could well hit many people who have lived in an area for years, who happen to own a house that has gone up in value by a factor of 10 or more, who are not necessarily rich themselves.  People who could not afford to pay the tax, who are mildly insulted to be suddenly told their home is a 'mansion', who do not aspire to that type of lifestyle,  and in a lot of cases, in Islington at least, are Labour supporters.  Knight Frank report that eight out of ten homes likely to be hit by the Mansion Tax are situated in Windsor, Sevenoaks, Islington, Wandsworth and Guildford.  Some Labour and Conservative MPs are concerned that the tax will hit “cash-poor homeowners, rather than rich overseas investors”. The tax in its present form is targeted at the wrong people.

I would argue that the main purpose of this tax, which should bear the neutral term ‘Property Tax’ should be, obviously, to raise some more revenue from those that can afford it, but that it should also be structured in such a way as to try and counterbalance rocketing property prices, particularly in London and the South East.

 

A recent commentator from the financial sector stated that he thought the London property market has become completely decoupled from the basic market functions of supply and affordability.  The London property market has become its own investment market, that has floated free from the low interest and low-inflation economy that is otherwise the current economic climate, and has become, in the words of Andrew Neil, a “global reserve currency”.  This situation is driving away ordinary people who want to live in or around the city, both aspiring buyers, and anyone trying to rent.  There can often be a big difference between the means of those that can afford to buy into the current market, compared to those that have lived in an area for years, and live there because that’s where they like to live, and not because they want to make money out of their homes.

  

I think the Property Tax should be based on a similar system to that in New York State, where the tax is levied as a percentage of the value of the property, but with the difference that the ‘value’ of the property should be based on the most recent price paid for the property, not a valuation.  This approach has the advantage that there can be no arguments about whether a property is correctly valued, since the price paid is the best valuation you can get.  It will not require valuations to be carried out, because the information will be readily available from the Land Registry.  And assuming that the tax is set at the right level, it will hit those that pay high prices hard, and not those who paid significantly less and just happen to be caught in the price spiral.  This should have an immediately deflationary effect on house prices, as purchasers will be thinking hard about the ongoing cost of owning a property if they pay too much for it, since they are effectively setting their own tax bill with the offer they make for the property, and it will ensure that only those that can really afford the tax have to pay it.  

Crossrail have still got it wrong

The Crossrail safeguarding proposals have recently been adopted into legislation, which means that the ‘safeguarded’ route consulted on in late 2014- early 2015 is now legally safeguarded, along with the “areas of surface interest”.  Which means that Crossrail/TFL/DFT can now continue with developing their plans to bulldoze large sections of the Angel.  

It seems that the level of protest at the public meeting I publicised in January has had some sort of effect, as the much loved Co-Op Bank Building has now been removed from the proposals, but the remainder of the block is still identified for demolition.  There is also talk that the RBS building is being reconsidered for the surface works site, but there is still a determination to build the actual station entrance on the west side of the High Street.  This is fundamentally wrong-headed.

Whilst the removal of the Co-op bank building from the site is a step in the right direction, it does not change the fact that a station entrance on the west side of Islington High Street will still destroy a number of listed buildings to make way for the railway, and it doesn't change the fact that Torrens street, as well as containing buildings of significant historical value, is also a completely inappropriate site, due to access issues and proximity to residential properties. 

Only the use of the RBS site for both the surface works and a new station entrance will actually deliver real regeneration to the area, which is what Crossrail is supposed to do.   

We need to continue to campaign for a solution that actually benefits Islington,  And that includes campaigning for a ‘metro; rail type solution, which would be less disruptive and destructive, and allow more flexibility of route and scope for new stations. 

What's happening at Owen Street?

Everyone who cycles or walks through Owen Street from Goswell Road to St John's Street would agree that the conflict between cyclists and pedestrians is a ridiculous situation:  Cyclists are directed to ride on the pavement, causing alarm and distress to pedestrians, not to mention the occasional fisticuffs.  Why is this?

The problem is, when the Virgin Leisure Centre was built around 2000, the road that passes along by the building was private, and for some reason, the Council at the time (under the Liberals I believe) agreed that it should stay private, with the result that the pavement on the side of the road between Owen Street and Owens fields was the only part of the road that is public highway.  (I should add that once you bump over the awkward dropped kerb shown in the pic above, the rest of the roadway leading up to St John Street is all public highway.)

The consequence of this loopy legal arrangement is that the Council is unable to direct cyclists onto private property for fear of being held liable if an accident occured, and so was forced to designate the pavement as a cycle track, with the dangerous and scary consequences that everyone is familiar with.  

Since 2007 I have been making attempts to try and either get the road adopted, or get an agreement for cyclists to use the roadway, and every time I have been told that the owners of the property would not agree to it.  I persisted however, and finally one of the Council's senior legal officers discovered that we had been dealing with an agent for the residential properties on the site, and not the Freeholder.  Legal officers then managed to contact the freehold owners of the site, who I believe are The Brewers Company, who were much more amenable to the idea of improvements to the operation of the highway in the interests of public safety.  

The freeholder has I gather, now agreed in principle to allow the use of the private road by cyclists, legal documents have been exchanged, and lawyers are now working on the final details, such as who owns the drains, and where the water goes when it runs off the Council's pavements into the freeholder's drain, and whose responsibility the drain is as a result etc (yawn).  Once this is sorted, the Council will change the road and pavement layout in the area shown in the picture, so that cyclists have a straight run through, and the pavement will become pedestrian-only, as most reasonable people might expect.  

We might even see the work being done this year, which would be great.