With the NHS continuing to face unprecedented pressures and a second Covid surge imminent, in September health bosses decided to close the Royal Free's children's A&E department and move services to the Whittington.
In the months since then, doctors, MPs, councillors and campaign groups have questioned how the decision was reached - and criticised a lack of transparency from local NHS bosses.
With the government launching a consultation on a wider NHS restructure which will see more decisions made centrally and power given to new “integrated care systems” (ICS), here we look at how decisions have been made regarding north London’s hospitals.
The partnership
The decision was made by North London Partners (NLP) - a "sustainability and transformation partnership" which covers the five boroughs of Camden, Haringey, Islington, Barnet and Enfield.
The “partners” involved include ten different GP federations, the North Central London Clinical Commissioning Group (NCL CCG), the five local authorities, and the hospital and mental health trusts operating in the area – including the Royal Free NHS Trust and the Whittington Health NHS Trust.
The decision to make a number of changes to hospital services was made, we are told, by this organisation's North Central London Gold "team".
In September 2020, NLP said a “number of clinical and operational groups” took part in the review of paediatric services and provided recommendations for the temporary changes.
The recommendations were approved “following consideration” by the North Central London Clinical Advisory Group and the London Clinical Advisory Group - two leadership panels within NLP.
We were told: “The final decision was taken by North Central London System Gold.”
The decision was officially made in September following discussions with staff.
The partners
The local borough councils are among the "partners", and NLP said council figures had been "represented" by the "system-leaders" who made key-decisions.
However, in December at a meeting of the Camden Council Health and Adult Social Care Scrutiny panel, councillors including Camden's health boss Cllr Pat Callaghan said she and her counterparts at the other four boroughs covered by NLP were "furious when we heard about this, because of the non-consultation".
At the same meeting, Kate Slemeck – chief exec of the Royal Free Hospital – said delays in public communication of the changes had been to some extent “because we had to make sure we were bringing staff with us”.
The meetings
This newspaper requested the minutes of meetings from the Gold Group and the Clinical Advisory Group in September under Freedom of Information law, but this request has been denied, with the NHS, arguing that to disclose the minutes could "hamper the debate or decision-making on specific strategic issues".
This means the public, doctors and nurses do not get to know how the decisions were reached, what arguments were made or even who was in the room.
The groups
The Clinical Advisory Group is chaired by the Dr Jo Sauvage of the North Central London Clinical Commissioning Group (CCG), along with Dr Chris Streather, medical director at the Royal Free NHS Trust.
Representatives from the CCG and other hospitals across north London also sit on the panel - but there is no representation from local councils, and the groups meetings are held privately.
The Gold group features many of the same individuals, including directors and chief executives from NCL NHS trusts. Haringey Council's chief executive Zina Etheridge is the only local authority figure to sit on the panel.
NLP told this newspaper: “We do not routinely publish the minutes and agendas of these meetings.”
This makes the NLP different to the boards of clinical commissioning groups and hospital trusts, which meet in public.
Medical staff
Senior doctors have repeatedly spoken to the Ham&High the lack of transparency. One member of staff said they continued to be concerned that "empire-builders" had long-term plans to move to a more regional-based approach with specific services based at different hospitals in north London.
A nurse based at a north London hospital added: "We are just being told what's happening. The meetings are all happening behind closed doors. We don't know who is making the decisions. All I have heard is that it's 'the gold group', but I don't know who they are."
The near future
Last week, the Royal Free chief exec Kate Slemeck told said children's A&E services will return to the hospital this spring, but that there would then be "discussions" as to the future shape of provision in north London.
An integrated care system (ICS) for the NCL is in the works be introduced later this year, while there are fears that “joined up decision-making" could lead to less public accountability.
The MP
Tulip Siddiq, MP for Hampstead and Kilburn, raised the issue of the temporary changes in north London's hospitals with health secretary Matt Hancock in mid-January. When asked about NLP's decision to withhold meeting minutes, she spoke of the importance of transparency.
She told this newspaper: "I will keep fighting to reopen the children’s A&E as soon as possible and make sure that the government and other health bodies are transparent about their plans."
The MP said the children's A&E at the Royal Free was "a lifeline" to families in her constituency, adding: "Since the announcement of its temporary closure, I have been scrutinising local health bodies to ensure that promises about reopening the service are kept and patient safety is not compromised, including at several meetings with my fellow Camden MP Keir Starmer."
She said Mr Hancock pledged to work with her to ensure the changes were reversed and children's A&E at the Royal Free was reopen as soon as possible.
The watchdog
Matthew Parris, director of the Healthwatch Camden charity, echoed concerns about transparency. He told this newspaper that the local NHS "being accountable is vitally important".
He added: "There's a danger that the lack of accountability, consultation and transparency happens by default. One of the issues at the moment is there are more big decisions being made which mean there's less time to discuss them in detail."
He said this is exacerbated by scrutiny panels having few meetings to oversee the work of local NHS bosses.
He continued: "With the way the NHS is changing we need to make sure it retains transparency in the way it makes its decisions. That's really important. We would be supportive of efforts to find out how decisions are being made."
The patients
Patient campaigner Alan Morton, from the NCL NHS Watch group, told this newspaper: "We think they are using Covid as an excuse to push things through. The worry is will they ever be reversed?"
Alan’s colleague Brenda Allan told councillors from all five boroughs at an October scrutiny meeting: “We are concerned the NHS will become more centralised and financially driven, less subject to democratic oversight, and more remote from its users, which would harm us all.”
The partnership
A spokesperson for North London Partners said it had "proactively made a number of temporary changes at pace" to ensure safe services over the winter.
They added: "These temporary changes have been made on the recommendation of senior clinicians and operational managers with the final decisions taken by leaders representing local NHS trusts and local authorities across north central London.
"We remain committed to consulting on any long-term service changes, while continuing to engage with the public as well as MPs and councillors.”
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