In North Devon, Mandy Mitchell becomes seriously ill with coronavirus. She requires treatment in the local hospital’s intensive care unit, where she is put into an induced coma for almost 100 days. 

On the fringes of Dartmoor a nursing home is in desperate need of PPE, left waiting weeks for a delivery. They call the same local hospital for help. As health care professionals struggle to fight the virus this hospital in North Devon also takes part in life-saving trials. 

North Devon District Hospital (NDDH) has been a beacon for the region in the pandemic, providing essential services and saving lives. Had proposed cuts to the acute services at gone ahead the story might have been very different.

In 2016, a ‘Sustainability and Transformation Plan’ for the wider Devon region was put forward. Encouraged by government policy and led by Angela Pedder, it could have stripped North Devon District Hospital’s most vital acute services – A&E, intensive care, stroke, maternity, orthopeadic and peadeatric services were all at risk.

In 2016 Pedder, then Chief Executive of the Royal Devon and Exeter NHS Trust, told The Guardian: “We have to make sure the services are sustainable 2, 5, 10 years down the line.” The cuts would be made by 2020, only four years down the line: the year we would need our health service’s resources the most.

The plans to centralise services would force some residents of North Devon, an ageing and growing population, to travel to Exeter. Depending on where you live and the weather conditions the journey takes over an hour. The ‘golden hour,’ the critical window for essential treatment after which mortality rates increase substantially, for many patients would be gone. 

Sue Matthews, a former nurse who spent more than 20 years in the NHS, was shocked by the proposals. “Everything was under review, all the services, there was no red line,” she says. “So I just said, ‘no, we’re the red line’.” As the North Devon treasurer of the ‘Save Our Hospital Services’ (SOHS) group, Matthews joined with other members to stop the plans. 

The cuts were proposed because Devon’s health and social care services were predicted to have a £557 million deficit by 2020. The problem, Matthews claims, is Devon’s historic underfunding. NHS trusts are funded by areas defined as Clinical Commissioning Groups (CCGs). Funding is based not on the size of the population and their needs, but rather the population’s income and the value of property within the CCG. Geographically, Devon is the largest CCG in the country.

Devon is a largely rural economy and the agriculture, fishing and seasonal tourism work tends towards minimum wage employment, so there is a lot of rural poverty, which means the vast and sprawling county gets less funding than some smaller NHS trusts.

Like many poorer, rural areas, such as Cornwall, Devon also happens to be a “beauty spot,” meaning millions of tourists descend on the county every year, increasing demand on the local hospitals. In regards to Devon’s aging population, “it costs four times as much to provide care for over 65s than for those younger,” Matthews says. “You would expect that to be key to the funding formula, but it’s not.” 

To fight the cuts, the ‘Save Our Hospital Services’ group started petitions and contacted MPs, including the then health secretary Jeremy Hunt, and organised the ‘See Red’ protests. 

In 2016, I was back living in North Devon. The hospital is in my hometown of Barnstaple, so myself and my then 70 year-old mother joined the 4,000-strong protest of red that gathered to resist these cuts. We marched down the high street thick and red as blood cells through the arteries of the town and congregated in the square, which was so full many were lining up along the wide, brown river Taw. The hospital was a beacon no one had ever imagined would be snuffed out. 

The proposed cuts were soon making national news. In the following weeks, more fundraisers and protests were organised across North Devon, and protesters went to London to march for the NHS in Parliament Square. The outcry was so great that the acute service cuts were never put in to action. Cottage hospitals were closed and by 2018 the county’s community beds had been cut by 71%, but NDDH’s services were safe. 

In 2020, the year the cuts were to be completed, NDDH again found itself on the national news. This time for its remarkable work fighting Covid-19.  

Denis Mitchell and Mandy Mitchell (not related), were NDDH ICU patients during the pandemic, and are two of the longest treated coronavirus survivors in the country. They spent 76 and 93 days in the ICU respectively, having been almost 100 days in an induced coma with a 50/50 chance of survival. After her recovery Mandy told Good Morning Britain the NDDH staff “were brilliant, the care was just out of this world.” 

On the Easter weekend of lockdown, North Devon-based Dr. Finola O’Neill was working from a nursing home in South Devon that specialises in tracheotomy patients. She had been waiting three weeks for PPE to be sent from the centralised Department of Health stores.

Dr. O’Neill gave her nurses what equipment she could obtain, and called NDDH saying the home urgently needed PPE. The hospital provided it within 24 hours. “NDDH has been more useful than the sources I would have expected,” O’Neill says. “Part of this is because the chief nurse at North Devon District Hospital is really good, as is the Covid lead. And hospitals are set up to respond to something really quickly – it’s the mindset and the responsiveness.” 

Working within communities, local services have established relationships with both people who need help and people who can help. This local advantage was embodied by consultant microbiologist at NDDH, Tom Lewis. He successfully he employed the knowledge of the sexual health team, who were well practiced in contact tracing, to fill gaps in testing. Unfortunately, he told Reuters, he was ordered to stop this initiative by NHS executives as this was a “Public Health England job.”

North Devon District Hospital was also one of 175 hospitals to take part in the truly “world-leading” national trials researching Dexamethasone – the steroid drug that has been a proven to cut the risk of death by up to 1/3. It is the best treatment we currently have for Covid-19.

Had the proposed 2016 cuts gone ahead to the acute services at NDDH by 2020 “more people would have died,” former nurse Matthews says, “It doesn’t bear thinking about the impact that the initial proposals would have had in North Devon.”

One might think this highlights the importance of local hospitals to rural communities, dozens of which have been closed or partially closed all over the country. But the battle for NDDH’s services is not yet won.

Matthews is experiencing a case of déjà vu. The 2016 protests have led to a more transparent management of services and she says the board has been more supportive. But she fears a new “savings” plan is on the horizon. “They call them savings, we call them cuts. We’ve never had an answer to the question: How much have you actually saved by the things you’ve done?” 

As a doctor on the frontline, O’Neill believes the local hospital is vital. “With Covid we wouldn’t have managed at all. And we just wouldn’t have managed without it at any point— we wouldn’t manage without it in a normal winter or a normal summer. We just couldn’t. It would be insane.”

This year we have seen the power of protest globally with the Black Lives Matter movement. The campaign against cuts to North Devon District Hospital shows that power can also be wielded on a local scale. We are not powerless. We can change the future, for the better. But we may have to gather and fight for the valuable parts of our community that would otherwise be taken away.