Keeping our community hospitals in Cumbria
Penrith and the Border has, I believe, more community hospitals than any constituency in Britain. We have them in Penrith, Brampton, Alston, and Wigton, and we border Keswick and Cockermouth. (The national average is one for every two constituencies). And they are, have always been, will always be, under threat. In 2005 they were almost closed by a stroke of the Secretary of State for Health’s pen. Thousands of Cumbrians marched in London, and one in four of all Cumbrians signed a petition to keep the hospitals open. They were saved and the Primary Care Trust and its successors have since committed to keeping them. But nothing should be taken for granted, because – to put it bluntly – the modern world has a problem with the “small”.
A fight has been waged for centuries between big, centralised, systems and local bodies, and the locals always seem to lose. Thus in the nineteenth century when our national budget was one tenth what it is now, and our population smaller, auction marts and railway stations, pubs and post offices proliferated. Cumbria had a local regiment, my village had three schools; and almost every town had a police station, magistrates’ court, and bank. Now, a torrent of super-markets in Penrith threatens high street shops, and giant farms are pushing aside family small-holdings. Auction marts, railway stations, pubs and post offices have vanished and HSBC is about to close its branch in Appleby. Primary schools such as Bampton, and High Schools such as Longtown have been closed; and so have the magistrate’s courts in Penrith and Appleby. It is easy to imagine future examples, (police stations in Alston, Penrith, Keswick, Wigton, Appleby, and Cockermouth sold to finance the building of a headquarters in Barrow?).
The National Health Service has always been under pressure to centralise. Modern medicine needs expensive machines and drugs, and highly specialised staff. Surgeons improve by performing countless specialist operations inhospitals serving a million patients. So why a community hospital? This has been the question since the very start of the NHS, when Aneurin Bevan announced in 1947 ‘I would rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of warm sympathy in a small one.”
But our needs are changing. In the next twenty years, we will have twice the number of people over 85 in Cumbria. Hospital admissions are likely to rise by 60 per cent because of increasing long years of chronic illness. This will be a financial disaster for the NHS: which could face an extra 20 million pounds of costs in Alzheimer treatment in Cumbria alone, each year. But more importantly it will be a human disaster. Let me take the example of an eight-five year old, who has just lost her husband. Her husband used to nail down the carpet, and drive her to the optician and the grocer. Now that he has gone, her house is less well-maintained, she cannot see clearly, and she is not eating well. Her likelihood of falling has soared; and once she has entered the hospital system, the chances are that she will face severe health problems, for years. This will cost the NHS tens of thousands of pounds, which could be spent on other services. But much more importantly it will be miserable for her. We are twice as likely to die in the year following a partner’s death than in any other year. Loneliness is a greater killer than smoking.
The solution to her predicament and that of thousands of others does not lie in giant, centralised hospitals: it lies in GPs and nurses, coordinating community support through community hospitals. She will be helped by broadband and mobile coverage, which will allow her to see grandchildren on a live video-link, monitor her health and chat to medical specialists from home. Broadband will allow visiting nurses to load medical data in real time. She would benefit from exercise, educational, and community activities in the community hospital. But the real key will be provided by voluntary organisations, such as CRUSE bereavement, Eden Carers, Eden Alarms, and Age UK, coordinated from the hospital. They alone can give the human understanding, which could allow her to live better for much longer at home. (Hospice at Home could help her to die with dignity at home: eighty per cent of Britons, say they would rather die at home, but almost eighty per cent die in hospital).
This will require a small shift of funding from acute hospitals towards community hospitals and voluntary organisations. It will not be simple. Ever since, the mill-owners at New Lanark discovered in 1786 that their seven storey brick fortress, could replace highly skilled local handloom weavers, with unskilled – often child – labour and produce many times as much cotton a day, the creed of centralisation and “factory-efficiency” has been pushed ever further. But such central planning theories are beginning to reach their limit. The most important problems of our age require re-engagement with the human- the culture, and history of communities, and the energy of their concern. I suspect this is why the grand dreams of international development and state-building have failed so repeatedly. I am confident that this is why we must keep our community hospitals in Cumbria.