Camden & Islington

In 2000, in London (United Kingdom), the specialized health system for children would required updating in the light of new technologies and the evolution of childhood diseases. Camden and Islington are boroughs of the city of London. In both, it was customary to treat sick children at home as often as possible, in a familiar environment and surrounded by relatives. This mainly concerned the so-called primary cares. On the other hand, the secondary care units of the two boroughs were becoming unsuitable. In addition, specialization training for paediatricians suffered from a reduction due to the national plan on medical resources. The capacity of the existing units was then questioned.

Until September 2000, preliminary discussions were held among stakeholders, culminating in the resolution “we must provide only pediatric secondary care and surgery in the hospitalization unit”. However, until November 2000, this statement remained abstract, disconnected from the actual actions of stakeholders. Consultants were then invited to participate in the resolution of these problems and especially for the ramification of solutions at the level of the different stakeholders.

The context of decision-making has been highly complex and uncertain, associated with the need to involve and engage multiple stakeholders. Several interconnected decisions were to be made simultaneously while considering incompatibilities and feasibility. There was also the political sensitivity of the considered problems, in addition to an aggravating factor: recent cessation of some subsidies on care, affecting the Camden and Islington boroughs and forthcoming elections. An inclusive decision-making method was therefore adopted, combining 4 different decision-making techniques, and a group of 12 stakeholder representatives was formed.

The two boroughs are characterized by a large number of public housing buildings, with a population of great ethnic and linguistic diversity, and busy neighbourhoods. The main problems encountered were: (i) the identification of the hospital that was to accommodate the units of hospitalized secondary patients; (ii) the ideal number of ambulatory health centres to complement the care provided by hospitals; (iii) how and to what extent community services should be strengthened.

The consultants prepared and facilitated three workshops: in January, February and March 2001. Then a final reporting point was organized to make the technical results more readable for policy makers. The official communication of the results had to be postponed because of fragile political situation. In April 2002, responsibility for planning health services in both boroughs was transferred to the North Central London Strategic Health Authority. The latter applied some of the measures resulting from the workshops: extension of the opening hours of the health centres, endowments of mobile health centres.

The participants are nevertheless satisfied with their work: “I think that one of the advantages of this group work is the consideration of Camden & Islington folklore. Tradition and beneficiaries have been considered in solving problems. Through this kind of strategic exercise, they were able to articulate and contribute to a rational reflection. “