The fiercest arguments were over the question of whether the new hospital for West Cumbria should be refurbished on the Hensingham site or new built on a site easily accessible to the population of Copeland and Allerdale. No more nightmares of the closure of the Accident and Emergency Department, or the Maternity Department, or the children's ward, or of cardiac patients having to be rushed from Egremont to Carlisle in a possibly futile race against the clock. At a public meeting on the Future of Acute Health Services in North Cumbria on 15th February, Health Trust Chief Executive, Marie Burnham, made her commitment to the best possible health services for West Cumbria clear when she retorted to a questioner that she would not be satisfied with getting a patient in a critical condition into hospital within an hour. Half an hour was the aim. And she was determined to ensure that the hospital was in place within five years.

The new hospital for West Cumbria, wherever it is situated, will provide emergency services with an Intensive Treatment Unit and maternity and children's services. The only thing that could be restricted to Cumberland Infirmary would be complex surgery, because it is essential for the patient's own safety that the specialist should have sufficient case load experience. It will also follow best clinical practice by moving patients to community healthcare settings as soon as possible and make specialist rehabilitation services more community based. You cannot have services more locally focused than in the patient's own home, Marie pointed out indisputably. The new hospital will be different from the existing one because it will support the most effective models of care. As an example, a patient in Egremont who suffers a stroke will be taken by ambulance to the stroke unit in the new hospital for immediate treatment. She will receive initial rehabilitation in the stroke unit by a team of specialist therapists, and after a few days discharged home to be supported by a community stroke support team. An asthma patient who might have had to go to an accident and emergency department every two months will in future be cared for much more effectively by an asthma nurse at his GP's surgery. More effective clinical practice frees up hospital beds for the most acute cases.

Consultant Mr Mahesh Dhebar (inset) spoke with passion as he appealed to the packed audience not to argue about the site. "Decide on the services we need first. They are much more important. Then choose the site most appropriate to the services." He urged local politicians to back the proposals, warning that there were forces that opposed a hospital for West Cumbria.

There were fierce arguments that nothing but a refurbished hospital at Hensingham would do, and some were baffled as to how it could be cost effective to close a working hospital and build another on a different site, but cost effectiveness would govern decisions, Marie Burnham declared. The final decision has not yet been made, but if we don't get it right the private sector will. Throughout the meeting she made clear her passionate commitment to the National Health Service and demanded that as many as possible of the hospital services should be delivered by NHS staff.

There was an amazing contrast in the mood of this meeting and previous meetings where staff at the hospital feared it would be closed down. "We have gained 95% of all we have been fighting for and thought we had lost," commented Alan Alexander in an upbeat assessment.