So are Cottage Hospital beds safe, or not ?

If a week is a long time in politics, it seems that two and a half weeks is a positive age in the management of the NHS.

That's how long ago a statement by the new Cumbria-wide Primary Care Trust (PCT) at a public meeting in Carlisle was interpreted as meaning that the nine threatened community hospitals in Cumbria, such as Millom Community Hospital and Keswick Hospital (Mary Hewetson Cottage Hospital) were safe.

I was rather sceptical of this: the PCT was certainly making sympathetic noises to the effect that Community Hospitals are part of the solution, not part of the problem. However, they also made very clear that the Community hospitals will not necessarily be offering the same services in the future that they offer today.

This week Sue Page, the Chief Executive of the PCT, told a board meeting this week that Cottage Hospitals in Cumbria will not necessarily have the same number of beds.

There is an insoluble problem here. You cannot pickle a public service in aspic, least of all one as complex as the NHS, and expect it to adapt to changing needs and circumstances. But people are right to be very cautious that proposals for change may in practice mean that some services are taken away.

If we could operate hospital beds with complete efficiency, it may very well be that we could provide a good NHS service with fewer beds than there are now. But unfortuately, we are not living in a perfect world. When any proposals for new hospitals or changes to existing ones are assessed, we need to provide the number of beds which will be required given the efficiency with which an NHS staffed by mortal human beings can reasonably be expected to acheive in practice - not the number which would be needed if the health service were perfectly managed.