It is now 11 years since I launched CHANT Cymru at the request of campaigners across Wales, fighting for local beds at community hospitals. Campaigners against the closure of Chatsworth House Community Hospital in Prestatyn had asked me to form CHANT Cymru—Community Hospitals Acting Nationally Together—to bring together local groups from across Wales campaigning to save their local community hospitals, threatened by the then Labour Welsh Government’s closure programme.

Widespread opposition to closure had already generated popular public protests across the whole of Wales, and CHANT Cymru was the campaigners’ national voice in the fight to save their community hospitals. We promoted at national level the role of community hospitals in providing quality healthcare, supported local campaigns and held the Welsh Government to account over its promise to meet the health needs of its patients and to provide accessible local healthcare. I led a debate on this here, we held a rally on the Senedd steps, attended by coachloads from across Wales, and we successfully ensured that this was a key issue in the 2007 Assembly election.

The new coalition Welsh Government announced a u-turn. In March 2010, the Labour health Minister said,

‘I am not aware of any threats to community hospitals across Wales’.

However, when Labour returned to single-party power in Cardiff in 2011, they again pushed ahead with their community hospital closure programme. North Wales community health council wrote to the then health Minister expressing concerns about the robustness of the information provided by Betsi Cadwaladr university health board, which they used to inform their decisions to close community hospitals in Flint, Llangollen, Blaenau Ffestiniog and Prestatyn. Dozens of community beds were lost, despite bed occupancy levels at 95 per cent and above. The GP who set up the north Wales pilot, the enhanced care at home scheme, with the health board, said that

‘This will bring a service that is currently frequently gridlocked, further to its knees’, and that

‘a central part of the proposed shake-up of health services—providing more care in people’s homes—won’t fill the gap left by shutting community hospitals.’

This Welsh Labour Government ignored the Flint referendum, in which 99.3 per cent voted in favour of returning in-patient beds to Flint, and then ignored the Blaenau Ffestiniog referendum where an overwhelming majority voted in favour of returning beds there.

When I visited Holywell hospital, staff there told me that extra investment in our local community hospitals, such as Holywell, and NHS community beds in Flint would take pressure off our general hospitals, help tackle the A&E crisis and enable the health board to use its resources more efficiently. As the head of the NHS in England said, smaller community hospitals should play a bigger role, particularly in the care of older patients.

At last June’s Royal College of General Practitioners Wales’s Assembly event, ‘Strengthening General Practice to Support the NHS’, we heard that general practice in Wales provides 90 per cent of NHS consultations, 27.8 per cent of the budget, and that prolonged underinvestment means that funding for general practice has been decreasing compared to the overall Welsh NHS.

‘Yet we face the significant challenges of an ageing and growing population. Consultations are becoming longer and more complicated as we deal with an increasing number of patients with multiple chronic conditions.’

We also heard from them that NHS community beds add to the breadth of things GPs can do, including respite and step-down care, assisting both primary and secondary sectors. If it really means what it says about co-production in health and social care, the Welsh Government must start listening to these professionals and designing and delivering local services with clinicians and local communities.

The Well North Wales programme identifies a requirement to tackle issues around deprivation and poverty at a local, community level via co-production. As the Chief Medical Officer for Wales said in his annual report 2015-16,

‘Social prescribing can improve self-esteem, mood, social contact and transferrable skills—and decrease demand for Health services.’

The Co-production Network for Wales, All in this Together, have highlighted, for example, the Green Dreams: Creating Health through Community social prescribing initiative, established by a GP in England. As Wales’s chief medical officer states,

‘Co-production with communities is a potentially powerful way in which public sector staff can respond to the social gradient of health need.’

‘The optimal arrangement of primary and community care services may be best understood through co-production.’

‘Understanding community assets and co-productive working seems vital for GP practices, primary care resource centres and primary care clusters.’

And, may I add, vital for community hospitals and community beds also?