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By Mark Gould...
By Mark Gould

'Reprieve for the cottage hospitals'. The newspaper headlines fluttered merrily like bunting at a village fete. All's well with middle England - those 80 ivy-clad war memorial hospitals and wisteria-decked community hospitals are safe thanks to health secretary Patricia Hewitt and her white paper on healthcare outside hospitals.

'We are clear that community facilities should not be lost in response to short-term budgetary pressures that are not related to the viability of the community facility itself,' stated the white paper.

The Tories harrumphed that it was a U-turn: but look a little closer.

Some hospitals may be reprieved in the future, but many of those that were under threat on 29 January were still due for closure on 30 January when Ms Hewitt made her announcement that 5 per cent of the NHS budget would be transferred from hospitals to treating people nearer to home.

Suffolk Coastal primary care trust was not swayed by either local protest or the white paper to change community hospital closure plans.

Suffolk Coastal PCT chief executive Carole Taylor-Brown said the document spelt out just what the PCT planned to do - bring care closer to home using community beds and locality care teams, steered and supported by community matrons.

But, she added: 'As part of this modernisation we are planning to close two of our inpatient community bed facilities as they are no longer clinically viable or suitable to provide a 21st century healthcare environment.'

She promises 'rejuvenated' community units in five locations, but Hayward Day Hospital in Ipswich and Hartismere Hospital in Eye will close despite strong objections.

Local protestors the Hartismere Action Group and the Hospital League of Friends have made a formal appeal against the closure. They are asking the Suffolk county council health overview and scrutiny committee to refer the decision to Ms Hewitt in light of the white paper's view that community facilities can act as 'step down' beds, easing pressure in the acute sector.

Carol Clarke, joint chief executive of the merged Kennett and North West Wiltshire PCT and West Wiltshire PCT, said campaigners battling to save nine local hospitals had misinterpreted the policy vision.

'The white paper does not say all existing cottage hospitals under consideration for closure or service change are reprieved. Quite the contrary; it says community hospitals of the future will have to be fit for purpose and deliver the range of services we have discussed and shared with stakeholders.'

She added that 'nearly all of our existing community hospitals are not fit for purpose', and would not enable the PCT to carry out the new national policy and switch from secondary to primary care delivery.

And she made clear that the white paper would not mean Bradford-on-Avon Hospital and some of Westbury's cottage hospitals will be reopened. 'The reasons for their closure are still valid,' she said.

The white paper stole muchof the thunder of campaign group Community Hospitals Acting Nationally Together (CHANT), a multi-party but Conservative-led group set up last year by MPs responding to constituents' anger over closures.

Its chair Graham Stuart, Conservative MP for Beverly and Holderness on the east coast of Yorkshire, has had a different experience to Wiltshire campaigners.

On the day the white paper was published, proposals to close minor injury units at Hornsea and Withernsea were abandoned. Instead, the units will be kept open for limited hours.

Claire Wood, deputy chief executive and chief nurse at Yorkshire Wolds and Coast PCT, said directors had listened to all sides of the debate. 'We appreciate the strength of feeling from the public to retain local health services in rural areas, but at all times our aim has been to create the best and safest possible healthcare services for our patients.'

She insisted the proposals to make changes were 'being made to ensure patient safety and not because of the PCT's financial deficit.'

CHANT vice-chair, broadcaster and journalist Boris Johnson, who is shadow minister for higher education, hopes the white paper will mean a reprieve for Townlands Community Hospital in his Henley-on-Thames constituency.

Townlands is threatened with closure under plans to demolish the site and sell off two thirds of it for housing to finance the building of a 'locality hospital'. South East Oxfordshire and South West Oxfordshire PCTs are more than£30m in debt, and under pressure to present a clean balance sheet by April.

Mr Johnson said the white paper 'sounds like the first good news we have had for a long time, and I hope that Patricia Hewitt will make sure that is indeed good news for the people of Henley'.

He said Ms Hewitt has made it 'absolutely clear' that community hospitals cannot be closed for short-term cash-saving reasons. 'Since the Townlands Hospital is both immensely popular and of huge medical benefit, we must hope that the authorities have no alternative but to keep it open.

'But I am not counting my chickens, and all of us who have fought to keep Townlands going should know that the struggle is by no means over.'

The Community Hospital Association, founded to oppose hospital closures in the 1960s, is united with CHANT. It welcomed the white paper and is taking Ms Hewitt at her word - or at least the newspaper headline version of her word.

Spokeswoman Helen Tucker said the NHS has already lost 1,400 community beds since 1999, and cannot afford to lose more.

'We look forward to news that those 80 community hospitals currently under threat of closure or loss of services will have a reprieve, whilst PCTs carry out what the secretary of state has instructed them to do - review their plans in collaboration with local people, and test all future proposals against the principles of the white paper.'

In the first week of January, CHANT was launched by Graham Stuart and Mr Johnson at a meeting of nearly 100activists from across England, where they talked tactics and shared tips on how to stymie closures.

The meeting was chaired by one of the most effective health campaigners in the UK, Elizabeth Manero, who rose to national prominence masterminding the campaign to save Edgware Hospital in north London.

The Edgware Birth Centre, as it is now called, is a thriving community hospital.

Now she is executive director of Health Link, a not-for-profit company which works to improve access to services for marginalised groups and give patients a voice in the NHS.

Ms Manero described a powerful arsenal of weapons, all of which make her very unpopular with NHS managers: High Court challenges, a prominent media campaign, support from royal colleges and other prominent bodies and forensic use of evidence to challenge decision-making.

She told the meeting: 'Community hospitals are an easy target - a quick way for managers to save money. So it's vital to capture the logic.

'These are effective, cost-efficient hospitals that keep people out of general hospitals.

'Closures are irrational on patient choice grounds - you don't close local facilities when we are supposed to be keeping the NHS local. It's irrational to ignore the local community - and of course in most cases local NHS managers are as distraught as you are at closures.'

Ms Manero said that campaigners needed to marshal the support of local authority oversight and scrutiny committees, which can reject local health planning decisions and refer them to the health secretary.

'We need to get 80 overview and scrutiny panels to refer 80 plans to the health secretary so that can't be ignored.' She also pointed out that where agreement can not be reached, the secretary of state can refer decisions to the independent reconfiguration panel, made of up doctors and NHS managers.

But she said: 'The IRP has investigated just once. The biggest problem is getting it past Patricia Hewitt: usually she throws it back as a local matter or says go to the strategic health authority.'

Peter Rainsford, chair of the Campaign Group to Save Wells Hospital, spoke at the meeting about the development of his campaign and how a charitable trust is set to take over the running the hospital.

'The campaign started when beds were 'temporarily closed' - it was an emergency measure a week before Christmas 2004. There were a lot of very cross people and a lot of raw energy, but it was a question of channelling that raw energy. We needed a leader to focus the campaign. We needed local MPs, GPs and we needed the media. We also needed an interpreter because the NHS doesn't speak English.'

After 10 months of campaigning, a public consultation and negotiation process began which came up with a plan to develop a rural centre of medical excellence treating NHS patients but run and managed by a charitable trust.

Helen Tucker gave examples of other solutions. She said imaginative management had also saved Rye Hospital on theSussex coast and Hoylake Cottage Hospital on the Wirral.

PCTs that are proposing closures already have the handicap of receiving below average capitation funding, according to Mrs Tucker.

She believes that the introduction of payment by results has made it more difficult for NHS commissioners who want to usee community hospitals as step-down facilities.

But the new code of conduct for payment by results would allow for tariff 'unbundling' - with payment split between the district general hospital where the initial admission was made and the community hospital where further treatment was carried out.

She closes with a warning. 'If PCTs are closing community hospital beds because of the financial technicality that they think they can't split the tariff, then I wouldn't like to be in their shoes.'

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