IT is entirely understandable that Justin Smallwood (Courier letters, August 29), in his capacity as Chief Officer of local charity "Upstream" would be in favour of the enhanced community service, or the "Health and Well-being Hub" (is this Orwellian Newspeak?) that the N.E.W. Devon Clinical Commissioning Group (CCG) is proposing for Crediton Hospital. However, as a retired local GP, and someone who feels strongly that this is the wrong direction to take, I would like to make the following response. The prime interest of those opposing these proposed changes, is in maintaining, indeed expanding, the in-patient hospital beds, partly because they are so necessary, but also because without them, there will be a domino effect of gradual reductions followed, inevitably, by closure of the whole hospital. In my view, the process would be as follows: 1) In-patient bed closure 2) A "hub" that finds Crediton Hospital too big for its purposes 3) Re-locating to a new and smaller hub 4) Selling off the site for another purpose or for cash - in spite of the very large financial input from the local community in that hospital - a hospital that is modern (1988) and purpose-built as a Community Hospital. It would be an extremely unpopular policy in a town and rural district that is already seeing progressive reduction in so many other services. 'CHALLENGING' Those making these decisions are, by and large, too young to fully and emotionally understand how challenging old age can be, something I myself failed to fully grasp when in practice. There is no guarantee that if care is offered in the community, rather than in the hospital, it will continue to be "safe", "dignified" and "appropriate", or that the "Hub" will be the all encompassing service proposed. Moretonhampstead Hospital, which has lost its inpatient beds, is a worrying example of what might happen. Changes there are moving at a snail's pace - not at all the exciting "hub" they were promised. In our view, it is absolutely clear that inpatient care is essential in Crediton, especially if linked in some way to the Royal Devon and Exeter Hospital (RD&E). There are so many reports of people unable to get a bed at Crediton (because the beds there have been deliberately run down) leading to often insurmountable problems for visiting, not just by spouses without cars, but friends too, the public transport or parking being so difficult at the often bed-blocked RD&E. REAL NEED FOR BEDS As regards the cost-effectiveness of the two options i.e. keeping the beds open or changing to a community hub model, it is hard to balance this against the very real needs for Crediton area inpatient "step-down" beds. What will be the cost of this proposed alternative of "massive" home care for far flung patients, in nurses' salaries, car-running costs etc? And see Dr. Sarah Wollaston's Website (visit from Simon Stevens the new Head of the NHS on August 7 2014: http://www.drsarah.org.uk/diary/simon-stevens-chief-executive-nhs-england/1234">http://www.drsarah.org.uk/diary/simon-stevens-chief-executive-nhs-england/1234 ) where she points to the difficulties of recruiting nurses. OK, that is not easy in Crediton hospital either, but inevitable if it is apparent to prospective employees that the hospital has been progressively run down for far too long. WHY THE MOVE? The bed costs may well compare unfavourably with Okehampton and Tiverton hospitals, but Crediton has unfortunately had a well-below optimal number of beds open. If a real grip was taken to link and liaise with the RD&E, where there are such overcrowding problems and with an ever-increasing catchment population around Exeter, Crediton could become as dynamic as Tiverton and Okehampton. The inpatient beds are now so run down that, of course, not many patients can be served there. This is an argument in part for restoring an optimum number of beds. (And why is the preventive and diagnostic consultant-led Dementia clinic at Crediton Hospital under threat of being moved to Tiverton, and in a so-called "Dementia Friendly town", i.e. Crediton?) As regards currently unused space in the hospital, this will become huge if all the beds go. It is unlikely, then, that even "improved services", including Justin Smallwood's "Upstream" will fill this vacuum and the inevitable process of closure, as outlined above, would start and the whole hospital would go, perhaps as Dr Mays suggested on May 8, at the meeting hosted by the Crediton and Area Branch of Devon Senior Voice, to accommodate the two town surgeries, possibly even requiring a re-build. But, if this were the case, even use of the extensive lawns as parking areas would not be sufficient. Crediton too is growing fast. WHAT OF NHS HEAD? Finally, where are the preferences of the new NHS Head, Simon Stevens, and the Health Minister, Norman Lamb, in all this? Referring to these interviews Dr. Max Pemberton summarised them well in "The Daily Telegraph" (June 2 2014): "At last an NHS Head who listens. I almost couldn't believe what I was hearing last week. "After years of doctors, nurses and patients bemoaning the closure of cottage hospitals and being roundly ignored, Simon Stevens, the new chief executive of the NHS, has said that he wants the closures to stop, and that more patients should be treated in their communities. "This is a significant volte-face for NHS policy, which has recently seen small, local hospitals close in favour of larger centres. "The Royal College of General Practitioners has been particularly vocal over the need for local beds for patients. SMALL IS GOOD "I agree that this is the way that the NHS should be going: small, local hospitals for general admissions and those requiring rehabilitation or step-down facilities, and then expert centres covering larger areas for more specialist procedures, treatments or opinions." See also an alternative "re-invention" (Simon Stevens) of Community hospitals to be run as a Social Enterprise: http://www.hsj.co.uk/comment/run-community-hospitals-as-social-enterprises-and-save-the-nhs-millions/5071826.article?blocktitle=Most-popular&contentID=-1#.VANsLNddWSp">http://www.hsj.co.uk/comment/run-community-hospitals-as-social-enterprises-and-save-the-nhs-millions/5071826.article?blocktitle=Most-popular&contentID=-1#.VANsLNddWSp . And yet the CCG apparently wants to close all the beds at Crediton Hospital! In summary: more than 3,000 people from Crediton and District have already spoken via the petition to "Save our Hospital beds". The community wants to retain a viable number of in-patient beds at Crediton Hospital. Maybe also try to accommodate a "Health and Well-Being Hub" so that this crucial local resource can be fully used. Dr Christopher Maycock supported by Mrs Pauline Thomas and Mrs Paula Kovacs of Crediton and Area Branch of Devon Senior Voice