Our health care is in a mess. That is one thing everyone can agree on. Years of mismanagement and a failure to address chronic staffing shortages have led us here.

The situation is so grim, so parlous for our health service, that something radical is needed.

I have some sympathy for the Success Regime because any changes suggested by them were bound to upset some people. Perhaps many.

We cannot continue with the status quo.

But maybe we need something more imaginative than simply cutting back on cottage hospitals (which was tried and failed before).

Instead of offering sustainable solutions, the Regime has prompted huge questions.

Reducing services in the west of the county will leave people living there feeling isolated and like second class citizens.

They’re not valued enough to have full-blown care for their children and babies.

Instead they will be ferried to the already over-stretched cumberland Infirmary in Carlisle in an Ambulance taxi service.

If they are lucky and there aren’t the usual roadworks and crashes along the A595/A596, their journey will take 40 minutes.

Downgrading services out west seems a bizarre move to make when you consider the nuclear expansion at Moorside and other developments expected in the region in the coming years which will see an influx of workers and their families who will all need fully-functioning health services, preferably in their locality.

As for staffing, if we’re reducing the services provided by the West Cumberland hospital, how do we hope to attract staff to a half-functioning hospital?

There are more questions.

Those patients who would be in cottage hospitals in Maryport or Alston – both miles from an alternative hospital and appallingly served by buses – are expected to be cared for where? At home? How? With what support?

The Regime says that changes have been made in the recruitment of staff. Last year, we had NO trainee GPS in the north and west of Cumbria. A truly shocking state of affairs.

The Regime says they have now recruited 12 trainee GPs. A cause for celebration and some relief, but how have they managed this? If they can turn that recruitment issue round, why can’t they recruit the staff necessary to man our community hospitals and a fully-functioning baby unit in the west of the county?

The suggestions made in the Regime’s discussion document point to a much darker long-term strategy for health care in the county.

They want to see more widespread, far-reaching at-home care, rather than patients in the community hospitals.

But it has not revealed what that community care would look like, what support there would be for patients and their families and how much it is likely to cost the health service and families.

Because at the end of the day, ‘community care’ boils down to people staying at home, being cared for by relatives (usually elderly themselves) and those relatives footing most of the cost involved.

The report points out that we are facing an increasingly aged population, creating what the report calls “a higher demand for health services and increasing pressure on social care providers”.

The long-range healthcare forecast is for us to have ‘Integrated Care Communities’ providing as much care at home or within nursing homes as possible.

So their real answer is for us to look after ourselves and to pay for it.