I came to a view in my early career as a community activist that there were three types of people one might encounter when trying to be active in the community: the fool, the villain and the good guy. I have somewhat modified that view since then to take in to account that there is a mixture of all these characters, and to varying extents, in all of us, and that there may be a fourth category that could well encompass the majority: the apathist – one who seems not to care one way or another what happens and chooses not to get involved, because he/she is apathetic.
Often, it is not easy to work out which category a person is in and people get it wrong who try – which is why wisdom (discussed elsewhere) is needed. Yet in order to get things done one needs to work with, and even be nice to, those in all four categories, ideally trying to work toward a common goal, although naturally one will try to rally and rally around the good guys! In a world where pride, money and power are often factors that determine what goes on, more than we care to think, it is all the more important that we find ways to come together in order to achieve our goals.
When I helped to start the Cluny Residents Association (CRA) some eight years ago, and became its first chair (and eight years on I am its current chair) I like to think my aims were mostly noble ones: to improve the community and in particular to encourage community spirit and discourage anti-social behavior. It hasn’t been an easy ride, and sadly many of the community we serve appear to be in the apathetic category, at least as far as getting involved with the activities of our association is concerned. I’ve learned a lot, and am still learning, especially that people do see things differently and have their contribution to make, and I need to respect this. One of the positives has been working with all sorts of interests in the community: South Essex Homes, the Council (councillors and officers), the Police, local churches and schools, etc. It is for others to judge how successful we have been, but I would like to think that by working alongside other agencies and individuals we have helped to make a difference and we have seen notable improvements.
One issue that cropped up in the early days was around health inequalities. According to government statistics, such as the now defunct index of multiple deprivation, St. Lukes scored highly – for example, average life expectancy was 10 years less compared with the most affluent wards, yet health provision, particularly at primary care level, was markedly inferior. Frank Gulley was someone who cottoned onto this fact as well as the then flavor of the month, powers-that-be agenda – extended schools – making schools the heart of the community, which was once seen as the role of the church but felt more appropriate in today’s multi-cultural, secular society. Frank was the headmaster of our local Temple Sutton primary school and, to give him credit, not only did he recognize this need in the community, but he also seized the opportunity.
He rallied community support and came up with a plan to give the community the health facilities, including projects promoting good health, many had come to realise were needed and long overdue, based on the school grounds. This dream did not materialise because of the government imposed austerity measures that was brought on by the current economic crisis and for other reasons that I don’t intend to go into here, firstly, because I don’t have all the facts to hand and, secondly, given my chess based philosophy of community activism, my aim right now is to win the end game. For a period, some of the ideas were kept on the boil and carried forward, although the Community Interest Company that took the lead on many of these matters eventually folded.
What did come out of all this toing and froing in order to improve the health provision in the St. Lukes ward, but without the hoped for ending, and where many others played a part in the proceedings, was that the idea was not lost. The New Labour vision to replace the church with the school as being the heart of the community sort of got reversed or at least balanced out, with St. Lukes church taking forward some of these ideas and running with them. Much has been achieved, a lot of it health related with, it is hoped by those involved, more still to come. While not a member of that church, I do have an interest and a view, as my book “Theological Musings”, available as a free download from this website, elaborates. My reading of history is that the church has often taken the lead when it comes to providing health care to the community, especially to the poor, and in many poorer parts of the world that remains the case. Also, the fact that St. Luke was a doctor is not without significance.
Interestingly, the health politics have moved on as invariably happens. No longer are we dealing with Primary Care Trusts and a government that seemed intent at throwing money at schemes like the one proposed, but new entities: Clinical Commissioning (doctor led) Groups and NHS England, with the idea that clinicians have more power, and where money is tight. One of the challenges when trying to effect change from a grass roots level is finding the right people to deal with, understanding the issues from their as well as our own perspective, including the decision making and other processes involved, as well as the not to be forgotten issue of monetary considerations, and then being able to present a credible case in the knowledge that we still won’t know all what is going on. Also, such are the vagaries of life that many important decisions are made on the whims of a small, not always the most worthy, elite but then I feel we mustn’t lose heart or our integrity. But I need to swiftly move on to my main point, which is about how to go about improving the health provision in the St. Lukes ward and, as much as I think these subjects are important, it is more than just about philosophy, politics and history and, come to that, individual egos.
One of the good things that came out of these deliberations was the St. Lukes Health Centre, currently and interestingly based next to the site earlier proposed, in a portacabin. It offers both extended hours and drop-in facilities to a wide catchment and is a popular and over-subscribed service although, like any other, not above criticism (one patient I spoke to expressed irritation that her sick husband sees a different doctor each time he visits and has to explain yet again what his issues are). Given this temporary solution has existed for a lot longer than most had expected and would have thought desirable, and according to newspaper reports could well extend a further five years, is one of the main matters of concern.
While I look forward to seeing the facts and figures, it appears the need has already outgrown the capacity of the present premises to deal with that need and other needed services (often associated with modern GP practices) where there may be a demand, that could be provided if permanent accommodation were found, have to presently be put on hold. The crux questions are what, where and when, to which one could add where does the money come from to pay for this and what is the business case? One suggestion being mooted is for the under used Council owned Cumberlege lodge, conveniently sited next to the temporary premises, to be fully or partly taken over. Some feel this could be an ideal solution but it will mean good will and joined up working between different agencies. It should be stated though that this is not the only possibility, and St. Lukes church may still have a further part to play.
While this is my nearest surgery, it is not one that I normally attend, although like others my family have benefited from the out of hours drop in facility, mainly because my family was already registered with the perfectly adequate Queensway GP practice just outside the area and we have transport to get there. For many others, often the elderly, disabled, child bound, vulnerable and disempowered, this is not a viable option, and in the meantime they suffer because we do not have this desirably sensible, on their door step solution and have to travel longer distances to get what they need.
At our CRA open meeting this coming Monday (17/03, 7-9pm at the Cluny Square community café) the whole subject will be aired and will be the main agenda item. We look forward to hearing from and quizzing representatives of NHS England (who commission the services, including holding the purse strings) and the health centre, along with our ward councilors who, refreshingly, have declared their commitment to putting aside party differences on this matter, in order to work together to find a solution that best serves the residents they represent. The aim of the meeting is to establish the facts, including the needs and what is and what isn’t possible, and see what we can do as a community to effect beneficial change.
I hope the relevant facts will come out and we will see the business cases transparently presented. I hope residents will attend this meeting and make their voices heard. I hope the interested parties will put aside differences, rally together, and work toward an end that best serves the St. Lukes community. The Big Society and localism agendas of the current coalition government now seems somewhat outdated but if community power means anything at all and we agree that a fair and socially just society is a worthy and obtainable goal, then a good solution needs to be found soon, such that the whole St. Lukes community will benefit. Moreover, in doing so, a worthy legacy can be passed on to our children and future generations that live in the ward, and we are that further forward when it comes to improving our community.
The meeting did take place and went as well as could be expected, with a positive outcome hoped for. One of my actions as chair was to write to NHS England. We await developments. The only real disappointment was that only a few of the residents attended although I well recognise this is one of the things one has to face when trying to make a difference in one’s community.