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May 05 2010

Remember 1983? I warn you that a Cameron victory will be just as bad | Jonathan Freedland

I would like to make a positive case for Labour, but the hour is late, and now it is Neil Kinnock's famous words that stir me

On the eve of the 1983 election – which, until this year, seemed destined to represent for ever the low watermark of Labour performances – a young member of the party's shadow cabinet delivered what was to be one of his most compelling speeches. Neil Kinnock knew a landslide defeat was imminent so, speaking in Bridgend, he sketched the world to come. "I warn you," he began, addressing a nation about to descend into the bitterest stretch of the Thatcher era. "I warn you not to be ordinary. I warn you not to be young. I warn you not to fall ill. I warn you not to get old."

It was a rhetorical masterpiece from a man whose oratory would later be much mocked. But its power was its prescience. Kinnock saw the Thatcherite tsunami that was coming and warned of the deluge that would follow.

This time even the most pessimistic Labourite cannot feel the certainty Kinnock had then: all kinds of permutation are still possible. But if the Labour vote crashes close to, or even below, 1983 levels, then David Cameron in Downing Street is the most likely outcome, whether governing as a minority, in alliance with the Lib Dems, or with a narrow majority of his own. What would he do if he gets there? What cautionary message might a 2010 Kinnock issue? For those still weighing their vote, here are a few salutary thoughts.

I warn you that a chance some have waited for all their adult lives will slip away, perhaps taking another generation to come around again: the chance to reform our rotten, broken electoral system. If Cameron wins, he will not only thwart any move to fairer voting, he will act fast to rig the system in his favour. Even neutrals agree that his plan to cut the number of MPs by 10% – presented as a mere cost-cutting measure – will be one of the grossest acts of gerrymandering in British political history. Cameron will redraw the boundaries so that his rivals lose seats and he gains them, locking in a semi-permanent Conservative majority. Reform of our absurd, unelected second chamber will be postponed indefinitely, enabling Cameron to pack the Lords with his mates and sugar daddies, including perhaps a few more of those businessmen who so obligingly sided with the Conservatives in condemning Labour's plans for national insurance.

If, on the other hand, Cameron is kept from Downing Street courtesy of a Labour vote tomorrow strong enough to make a Lib-Lab coalition plausible, then there's a clear chance for the 55%-plus majority who regularly vote for liberal or left parties to prevail and reform the system – ensuring that, from now on, the Conservatives hold power only as often as their minority status suggests they should. (They were always a minority party, even in the Thatcher heyday.) In other words, the victor tomorrow will get to set the rules for decades to come. This is a winner-takes-all election and the stakes could not be higher.

I warn you that the economy could slide back into despair. Maybe people have not paid attention to this argument because Gordon Brown has been making it, but the danger is real. A sudden shut-off of the public spending tap could well send a frail recovery staggering back into recession: the dreaded double-dip. It's happened elsewhere and could happen here. The US and other economies are seeing the tide turn, but that's because they've kept the public cash coming. Cameron's aim, played down in the rhetoric because it polled so badly, is to cut spending immediately, ushering in what he once proudly trumpeted as an "age of austerity".

If Britain were to return to recession, then brace yourself. For many, this last downturn has not quite felt like the worst since the Great Depression, whatever the economists say. Unemployment, house repossessions and bankruptcies are all fractions of what they were in the 1990s recession. That's not by accident. It's a function of Labour's active interventionism, which has sought to reduce the impact of the downturn on those at the sharpest end. Such state activity clashes with every Conservative instinct. Cameron still describes government as more problem than solution. Last time the Tories were in charge, dealing with a recession that was actually much less severe, the pain was greater and the weakest suffered most. There is nothing in current Tory policy – despite Cameron's final debate plea to the camera that it's "the most vulnerable, the most frail and the poorest" he truly cares about – to suggest it won't be like that again.

Indeed, there are at least three signs that point in a gloomy direction. First, despite all the austerity talk, the Tories have clung to their promise to give an inheritance tax break to the 3,000 richest families in the country. In the words of Nick Clegg, it's the "double-millionaires" Cameron wants to help. And yet, given the hole in the public finances, cash will have to come from somewhere. The obvious source – not that the Conservative leader has ever been challenged on it – is an increase in VAT. That's the most regressive of all taxes, inflicting disproportionate pain on the poorest: pain that will only deepen with the coming Tory assault on tax credits. A third cause for alarm can be expressed in three words: Chancellor George Osborne.

I warn you not to have an urgent need for the NHS. Sure, the Tories say they've ringfenced health spending, but check the small print. They plan to drop Labour's guarantee on waiting times. No longer will any patient be sure to see a cancer specialist within two weeks: under the Tories, that decision will be left to the consultant. Fine for the sharp-elbowed middle class, who are used to barging their way to the front of the queue. Not so good for the poorest who, all the data shows, struggle to get the most from public services.

I warn you not to be a single mother or widow. You'll get less than those who are married. Not that much less – about £3 a week – but just enough to know that the tax system regards you as a second-class citizen and to remind you of how life used to be under the Conservatives, when single parents were a routine target for public mockery and scolding.

I warn you that we will be back to the sterile relationship with Europe of the 1990s, a British government once again on the margins, but aligned this time with homophobes, rank antisemites and assorted apologists for fascism. Prepare within weeks for a Cameron stunt, demanding negotiations to "repatriate" powers back to Westminster. Britain is set once again to become the club bore of the EU, happily swallowing the agenda of economic liberalisation but moaning about sovereignty in the abstract, annoying the other members but never having the courage to up and leave.

Cameron won't have much choice in the matter. He'll be answerable to the newly-strengthened backbench hard right of his party, who will have veto power over his programme: he won't be able to govern without their votes. With their loathing of Europe, their disbelief in man-made climate change and their disproportionate ties to the City and finance, they will ensure Cameron sticks to the right and narrow.

Of course, it would feel better to make a positive case for Labour, echoing its promises on a living wage and a cap on predatory chargecard interest rates or its plans for green jobs. But the hour is late. Tomorrow is the day of decision. And we have been warned.

• More election comment from Cif at the polls


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April 12 2010

Campaigners fight sale of Finsbury Health Centre

North London building designed by Berthold Lubetkin that served as a model for NHS could be sold to developers

"Cheerful atmosphere," reads a document on the design principles of Berthold Lubetkin's renowned Finsbury Health Centre, describing the entrance hall flooded with light through a wall of glass bricks, the clean surfaces and bright colours. "Air of efficiency gives confidence to the patients."

Built in 1938, the centre was conceived as the antithesis of the cramped slums, stale air and ill-health surrounding it in what was one of London's poorest boroughs. ("Nothing," the pioneering modernist Lubetkin famously declared, "is too good for ordinary people.") With its integrated services, free at the point of delivery under one roof – its facilities included a TB clinic, podiatry, a dental surgery and a solarium – it served as a model for the National Health Service that would be founded 10 years later.

Now, however, the centre is in a poor state of repair and faces the threat of closure. A battle is raging over its future, with the primary care trust, NHS Islington, insisting the £9.1m it says it would take to refurbish the Grade I-listed building would be better spent on doctors and nurses, and services housed in "appropriate" buildings.

It plans to sell the centre to developers and relocate the services – today it houses two GP surgeries, physiotherapy, dentistry, the Michael Palin Centre for Stammering Children and more – around the borough.

"As the owners of a Grade I-listed building, we are responsible for finding an appropriate future use for it, and we are committed to making sure that this happens," NHS Islington said.

"Our job is to provide quality healthcare services in modern and suitable premises that are accessible to all local residents. We're not here to look after historic buildings."

But local campaigners – backed by Islington council, English Heritage and Lubetkin's daughter, Sasha Lubetkin – are determined the building should be restored to its former glory and adapted for modern use so it can remain within the NHS.

Earlier this year the council's health and wellbeing review committee concluded that the work could be carried out for as little as £5m. The figure is backed by John Allan, a director at Avanti Architects – who repaired part of the outer wall in the 1990s – and would be no more than the cost of disposing of the building and scattering its services, he claims.

"One of the key aspects of its arrangements was that it was planned in such a way as to be extremely flexible," Allan said. "It's perfectly viable both to repair and restore, and to modify."

The work should be done not just because of the centre's historical and architectural significance – it attracts enthusiasts from around the world – but most importantly to serve local health needs, he added.

"It's still a vital and deeply loved resource for its local community – many of the current patients are children or grandchildren of the original ones.

"It was 10 years ahead of the NHS, so a major piece of social progress that we regard as a quintessentially British invention was actually foreshadowed by that building.

"It's really the grandparent of the service and the ideals we have now."

Russian-born Lubetkin moved to London in the early 1930s, establishing the radical Tecton architectural practice soon after.

In 1934 he was commissioned to design the much-admired penguin pool for London zoo, and the following year got the opportunity to apply his conviction that architecture should be a tool for social progress with the Finsbury project.

Commissioned by the local council – known as "the people's republic of Finsbury" for its leftwing radicalism – he designed a building that would not just offer treatment but also aim to inspire its patients to live healthier lives.

Murals by designer Gordon Cullen encouraged visitors to "live out of doors as much as you can" and enjoy "fresh air night and day", and while the world it inhabited was gloomy and smog-choked, inside the building the walls shone with cheerful reds and azures. One of the services on offer was "electrical treatment" – artificial sunlight.

In contrast to the traditional doctor's waiting room, with its strict rows of wooden benches, the foyer housed modernist furniture, casually arranged for a welcoming atmosphere. Patients were meant to feel the centre belonged to them, and that they were free to drop in whenever they needed.

NHS Islington's board has agreed to meet the council's health committee and formally consider its recommendations late next month. If its members remain unmoved, the decision is likely to be referred to the health secretary.

"NHS Islington is committed to reaching local resolution on the future use of Finsbury Health Centre," Paula Kahn, who chairs the primary care trust, said. "We hope our meeting with the scrutiny committee to discuss their report and recommendations will take us one step closer to achieving this."

Barb Jacobson, who is leading the campaign to save the centre, hopes the discussion will make a difference. "The evidence is extremely strong," she said.

For Allan, the battle to save the centre has a symbolic resonance. "Battered and bedraggled as the NHS may have now become, this marvellous building remains its noble progenitor and still embodies its original promise of public service. That promise must not be betrayed."


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March 21 2010

Circle hospital/ Foster & Partners

It looks like a five-star-hotel, but Norman Foster's Circle hospital in Bath could revolutionise patient care

"We wanted to put hospitality into hospitals" says Ali Parsa, the eloquent, confident managing partner of health company Circle, and "a night in a hospital costs more than in a five-star hotel, so why shouldn't people get a similar experience?" Indeed, the first reaction on entering Circle's new hospital outside Bath is that you've entered a hotel by mistake. There's a cheery brown-uniformed concierge, a scent of non-hospital food, and a clean-lined, light-filled, stone-paved modern interior with large cylinders of gauzy cloth hanging, like giant lamp shades, from the ceiling.

The last space I saw like this was the lobby of the Shore Club hotel on Miami Beach, also hung with gauzy cylinders (and whose bedrooms, as it happens, were so relentlessly minimal that they resembled those in a sanatorium). It's a comparison that would make Parsa happy. Circle's aim, according to one of his medical partners, is to "give people good health, not an experience of illness".

In most cities, if you look for the most lumpen, ungainly, charmless building, hospitals from the 1960s and 1970s will be near the top of the list. Gartnavel general in Glasgow, the Royal Liverpool, Addenbrooke's in Cambridge, the Royal Free and Guy's in London, to name a random few, all follow the same type. They are silos for the sick; multi-level garages for parking the unwell. Inside they are more like the interiors of aircraft carriers, vast unwindowed complexes linked by bewildering networks of corridors. You might have thought some decency and dignity would be suited to places where people are born and die, but the makers of these hospitals didn't seem to agree.

Places supposed to make you feel better start off by making you feel worse, and there are reasons, or excuses, for this. It's hard to justify a pound spent on an architectural nicety that might otherwise go on medical equipment, and hospital design is framed by guidelines about hygiene and efficiency to a greater degree than almost any other building type. If there were a contest for budget between aesthetics and saving lives, saving lives would naturally win, and never mind that administrative bureaucracy is rarely presented with the same challenge.

Yet, according to another Circle medical partner, Jonathan Boulton, people are healthier if they are relaxed. Their heart rate is lower, he says, they bleed less in operations, require less aggressive anaesthetisation, and are more likely to respond well to their treatment: "All the really bad outcomes tend to come with anxious patients." Good design can contribute to people feeling relaxed. For this reason, Circle hired Foster & Partners to design their Bath hospital, and are getting other celebrated architects, including the practices of Richard Rogers and Michael Hopkins, to design other hospitals now in the pipeline.

Circle is a business, the first of its kind, in which medical staff are partners, in order to "give them more control". It is planning other centres in places including Plymouth, Reading and Edinburgh. Its income comes mainly from private patients, either on insurance schemes or paying for themselves, but it also treats National Health patients, and expects to do so more.

Ali Parsa is a former investment banker with Goldman Sachs, and his approach is bracingly business-like – image consultants were brought in to create the Circle brand, "a sign of inclusion, continuity and perfection". The Bath hospital is located, practically but unsentimentally, in a business park, next to Audi and Mercedes Benz dealerships, albeit on the edge of rolling countryside.

Circle's aims include "no compromise on clinical outcome", a determination to "change how hospitals are run from the bottom up", and to be "relentless about changing patients' experience". So doctors were allowed to specify exactly the equipment they thought best, and sophisticated systems were installed for managing patient information and the supply of drugs. A chef was brought in from the Michelin-starred country house-hotel and spa, Lucknam Park.

And the gigantic, award-laden practice created by Norman Foster was asked to design their very first hospital building. In recent years, the Foster company has been making headlines with extravagant blooms, like a project in Moscow seemingly made out of multi-storey orange segments, but the Circle commission brought them back to more strait-laced principles of 20 years ago.

The important things, according to Foster partner Spencer de Grey, are "the clarity of the basic diagram, generous space, easy orientation, natural light and natural materials". Corridors were abolished, where possible, and signs kept to a minimum, as the building is sufficiently clear for people to find their way about without them. Much of the floor is in oak, the architects having demonstrated that it would be no less hygienic than the more conventional lino. Lavender grows outside bedroom windows. Operating theatres, usually windowless, are here day-lit.

The impressive thing is that the building does exactly what its makers say it does. It provides obviously good things that somehow get missed out of other hospitals. If we want our surgeons to be wakeful and happy, which I think we do, it can only help if they can see clouds and sky and sunshine when they take a break. And it can only be beneficial if patients are calm rather than bewildered on arrival.

We have learned to be wary of bankers bearing magic potions, but in Parsa's case there is no catch. Personally, I find the relentlessness of Circle's management-speak unnerving, but when they call their Bath building "one of the finest hospitals in Britain", they're right. I also think the idea of a humane architecture could be taken much further – there's still something mechanistic about the way it delivers its good things of light, nature and clarity – but it is still a triumph to have these good things at all.

The government is embarked on a many-billion-pound programme of rebuilding hospitals, under its little-loved private finance initiative. There is every reason to believe it will deliver the same kind of clunkers, with updated styling, that were built over a generation ago. The important question is whether the principles of Circle Bath can be applied to much bigger hospitals, in the less charmed world of the National Health Service.

Parsa and de Grey both insist that they can. They say that they worked to a budget similar to those of NHS hospitals, and that future buildings will be cheaper now they've learned from the experience of their first hospital. They say the principles of their Bath design can be adapted to bigger buildings, and even that the climate of the NHS is changing in favour of their approach. I hope they're right, and that someone in the National Health Service is paying attention.


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