Ten years ago north Cumbria was in the midst of a battle to save its cottage hospitals.

Health bosses cited financial pressures as the reason they wanted to close beds and facilities.

People waved placards in the streets, petitions were signed and campaigners even took their fight to Westminster.

Among those leading the charge was John Howarth, then a Cockermouth GP, who came up with a counter proposal that painted the community hospitals as the solution rather than the problem.

His vision was to invest in them, so they could keep patients out of expensive acute hospital beds and expand the role the buildings played in their local communities.

Bosses listened and the hospitals were saved – until now.

A decade on and the future of the hospitals – in Brampton, Wigton, Alston, Penrith, Maryport, Keswick, Cockermouth and Workington – is again in doubt. This time it is part of a much wider review, led by the Government-appointed Success Regime, to rescue north Cumbria’s NHS from ever-spiralling problems.

Most of the problems lie within the big Carlisle and Whitehaven hospitals, which are in special measures, struggling to recruit staff and more than £60m in debt. But to solve them, the Success Regime is looking at the wider health system, bringing the community hospitals under scrutiny.

Initial options include closing some, if not all, of the community beds and instead care for people at home. The hospitals would become community hubs, hosting clinics and other services. Although not formal options – they will be unveiled in June – campaigners are worried.

However this time Dr Howarth cannot lead from the frontline.

Following the previous campaign, he moved into management, working inside the Cumbria Partnership NHS Foundation Trust, which runs the cottage hospitals. He is now deputy chief executive.

Asked if he is now poacher turned gamekeeper, he insists that is not the case. “I still see myself as a poacher really,” he says.

“There are a number of clinical leaders in Cumbria who are driven by principles. When things get really challenging I think we have to go back to those values – to think about why we came into medicine and value our communities and local connections.

“We should be proud of our community hospitals in Cumbria. They have roots deep in the communities. Staff deliver fantastic patient care – some of the most caring in the NHS – and the feedback we get is outstanding.”

But even as a huge supporter of the hospitals, Dr Howarth admits that the situation is not the same as it was 10 years ago. “I think the world has changed from where we were in 2006/07.

Cottage hospitals montage photo

“It is much more challenging to staff them. Across the health sector in Cumbria we’ve got real recruitment issues. Community hospitals unfortunately do not escape that,” he explains.

In cottage hospitals, with beds spread over multiple small sites, staffing problems are heightened. New national safe staffing ratios have added to the challenge and left some beds closed since Christmas.

In total, the hospitals have about 130 beds, ranging from six in Alston to 28 in Penrith.

“We have struggled to keep every bed open. As a trust we’ve been real supporters of community hospitals. We’ve protected them, looked after them and kept them well staffed. But we are struggling at the moment. Meanwhile the financial challenges in north Cumbria are also worse than in 2006/07 – multiple times worse. It’s like a number of storm clouds coming together,” he says.

Yet the partnership trust, with a debt of about £7 million, is generally fairing much better than the acute trust. So is it fair that its services are under threat? Although keen to protect the hospitals, Dr Howarth believes the only permanent solution is to look at everything together.

“Historically we have always had an acute trust lens on everything. Now we have a whole system lens. But that inevitably brings the community hospitals in for review,” he adds.

“The question is what does the future 21st century community hospital look like? Some will have medical beds, some may have nursing beds with social care. Around the country they have evolved, become community hubs. All options are on the table.”

To date the League of Friends’ groups have held off launching huge protests, instead holding talks with bosses. But in the past week momentum has started to shift, with online petitions and Facebook campaign pages springing up.

The smaller, older hospitals are most at risk – namely Brampton, Wigton, Alston, Maryport and Keswick. One proposal is to centralise beds on fewer sites.


John Holland But John Holland, of the Brampton group, believes the gaps left behind in large rural areas will end up costing more.

“I am genuinely not convinced that sending teams of district nurses out to people’s homes is going to be cheaper,” he says. “Also, why should people who live in sparsely populated areas have worse services than those in a bigger city? It’s bordering on discrimination.”

He believes closing beds would simply shift more pressure on to the infirmary. He also fears that once beds are gone, the cottage hospitals’ long term future will be doomed.

“It would be so easy then to say it’s not working. We have to close them and sell off the sites,” he adds.

Eveline Dugdale, who represents Wigton, is calling on the people of Carlisle to help by attending a public meeting in the city’s Tithe Barn next week. “I am asking them to support us because, if these beds go, their chances of getting into the infirmary are a lot less,” she says.

Mrs Dugdale is also questioning the financial argument for closing community beds.


Eveline Dugdale “As far as I can see they haven’t costed anything,” she says. “We are also extremely concerned about social services. They keep saying people will be cared for at home but social services haven’t got the money or the people to do that.”

Sarah Cousins is practice manager of the Maryport surgery. She says GPs are very worried about the potential implications of losing the inpatient beds, which help them keep patients out of the acute trust and nearer home.

Dr Howarth is disappointed that the hospitals didn’t all get the investment promised by the Government in 2007/08.

“We got caught out by the financial crash and all the capital budget disappeared.

“Cockermouth got built by the skin of its teeth, partly due to the fact they were working out of temporary buildings because of the floods,” he says.

However he says his trust has maintained the buildings well.

In terms of the Success Regime, he says although it may be uncomfortable to hear beds are under threat, he would rather all options were made public than being discussed behind closed doors.

“Having lived and worked here for most of my career, I really want the voice of the public to be heard,” he says. “We can’t duck these issues. This is by far and away the most challenging set of circumstances I’ve come up against in 33 years of being a doctor. The best way to solve it is listening, understanding and working together.”

A series of public meetings get underway in the next few weeks, including at Carlisle’s Tithe Barn at 6.30pm on Tuesday and at Maryport Rugby Club on May 5. 


Weblink:   www.successregimecumbria.nhs.uk .