Dr Paul Arnison-Newgass, of Clarence Hill, Dartmouth, writes:

As reported in the Dartmouth Chronicle and a ­letter from the Dartmouth Patients’ Group, September 30, I agree that, as they say, the latest NHS plan does ‘have merit’, but I suggest that they have glossed over a number of local factors peculiar to Dartmouth and the merit evaporates.

Principally, Dartmouth is the ‘end of the line’ – isolated by distance, a poor road network and public transport – from comprehensive medical care, including A&E. Torbay Hospital is excellent, but ­distant.

We need the comprehensive ­services of a functioning cottage hospital, and the needs are not dissipated merely by changing its name.

The NHS has of course been plagued for years by four ­maladies – accepted now as mantras, seemingly irreconcilable, that dominate all. They are:

* bed blockage;

* age – we are getting older;

* abuse of A&E for trivial ­complaints; and

* failure of local authority ­community care services and coordination with the NHS.

The closure or degrading of local ‘cottage’ hospitals will only exacerbate these chronic problems and solve none. Typical of the ‘new broom’ ­initiatives of yet another NHS reform, which as always sweep away hitherto well-functioning structures without genuine substitutes.

The many platitudinous papers from NHS and commissioning groups all stress the benefits of comprehensive local care hubs and the ‘voluntary sector’ substituting for closures and reductions of cottage ­hospitals, but failing to make clear that ‘local’ in many cases means 40 miles down the road and consequently isolation from the benefits – and the good will – of local friends, families and carers.

That care hubs may be ­substitutes for cottage hospitals is little more than a confidence trick. Cottage hospitals have for years provided a level of ­accessible comprehensive care at a fraction of the cost of ­general hospitals; they had allowed GPs to provide for out-of-hours emergency care, now conspicuously excluded and ‘outsourced’ in hugely advantageous contracts. Illness does not stop at five o’clock.

Doubtless care hubs will claim to coordinate care ­services (nine to five, anyway), perhaps provide a few more and depend increasingly on presumed – and unspecified – voluntary sector support.

The smugly stated aim of ­supporting patients in their own homes or in community care ignores the continuing ­failure to link – as in joined-up – functionally and progressively the NHS with local community/social care. These two spokes of the care wheel fail to emanate from the same hub – indeed, they are not even on the same axle.

The Times’ (Saturday, October 15) health editor Chris Smyth is a breath of fresh realism that deserves to be taken seriously. He says that the NHS should step into long-term residential care that local authorities have failed to provide. The NHS has excess real estate second only to the Church and the MoD, and that ought to be used for the creation of residential social care or temporary stepping stones for the pejoratively termed ‘bed-blockers’.

This would be logical, given that such patients by their very nature would bring health problems over and above ­simply old age that should be cared for in local community homes with direct access to NHS support services. Staffing and recruitment of NHS-run care homes would require fewer, and less costly, ­qualifications than acute ward or specialist nursing staff; ­furthermore, one might hope that flexible employment would attract nurses and carers out of retirement, as well as a new category of care assistant – more equivalent to the long-gone but valued state-enrolled nurses, who did not require university degrees to teach them how to care. If willing, GPs could play a full part.

So, of the aforementioned four maladies, two of them – one and four – are resolved even if we continue to get older.

Some of the NHS care homes could also provide ‘care breaks’ for rest or continuing therapy. Age remains unsolved. However, it must be acknowledged that the continual emphasis on the increasing age of patients and their apparently expensive health problems ignores the immeasurably improved overall health of the majority compared with, say, 50 years ago, because so many today have lived healthier lives and embark upon old age in better health.

In addition, increasing day-case management, lighter anaesthetics, less-expensive procedures and shorter in-patient duration have all reduced hospital costs while allowing for more expensive, sophisticated regimes.

Furthermore, our commendably improved mortality rates are predictable to planners and bean counters and will not grow exponentially – short of divine intervention – and will at least partially offset the penalties of age for those of us fortunate enough to survive the inevitable brush with mortality along the way.

The fourth, unsolved malady – the abuse of A&E departments – would be improved, if not solved, by insisting that GPs accept some responsibility for the out-of-hours care of patients – ie after 5pm or 6pm. This would require some revision of their – hugely advantageous – GP contract along with improved emergency treatment facilities and staffing incorporated into the vaunted care hubs or local minor injuries units. Holding seriously ill or injured patients in ambulances in hospital car parks is a disgrace that seems to have now become an ­accepted norm. Removal of ­cottage hospital services locally to distant sites provides absolutely no advantages – it is wholly counterproductive.

So, before NHS planners grab yet another meaningless platitude, it is a shameless ­evasion of truth and responsibility to claim that all we need is to promote well-being, self-care and ill-health prevention. No doubt laudable, but where is the proof that this would free hospital beds and empty A&E departments, even if it makes the planners feel better? Accidents and severe ill-health will strike regardless: babies need to be born and mortality remains part of the human ­condition, even if we manage to postpone it a bit – but then, of course, we shall be blamed for getting older.

So I urge us to take part in the community consultation questionnaire by November 13, which can be found at www. communityconsultation.co.uk. But beware that typically the questions are skewed so as to invite answers that the

planners want, as was the covert purpose of the recent so-called consultation meetings.

We need to emphasise the peculiar needs of Dartmouth and its surrounding communities. We have been represented poorly by the Dartmouth Patients’ Group, which is ­pushing us prematurely into a half-baked plan.