In 2014, Alston Moor had a six-bed community hospital, a minor injuries unit, a 13-bed care home and a community ambulance service, serving a population of 2,400 people recognised by the government's own indices of deprivation as the most isolated community in mainland England. A midwife and a health visitor lived on the Moor, and a nursing team cared for both the inpatients and the minor injuries unit between them. The people delivering care here knew this community, house by house. The ambulance never got lost; it knew exactly where to go.

Most of that has since gone. The hospital's inpatient beds were formally closed in 2018. During the pandemic, the nursing team and the midwife were moved to Penrith, 20 miles away, and never came back. The minor injuries unit is gone. The X-ray department is gone. Only three of Grisedale Croft's 13 beds are occupied, and Westmorland and Furness Council (WFC) is now consulting on whether to close it altogether, or cut it down to as few as four beds — hardly room for the two step-down beds the NHS already promised, let alone a growing and ageing population. The ambulance service no longer exists in any meaningful sense. What is left are community first responders, capable of starting CPR and recording basic observations. A fully crewed ambulance, when one is needed, more often than not takes three to six hours to reach us.

There is a human cost here that no options appraisal will capture: loneliness, isolation, and fear. None of that shows up in a spreadsheet, but it is every bit as real as the figures you have put in front of us, and it is time it was weighed as such.

People from this Moor are already being placed in care homes many miles away, where visits from friends and family become rare instead of routine. There is no respite care here at all, so unpaid carers already exhausted by round-the-clock caring have nowhere nearby to turn. And when someone is dying, they are too often sent to a bed miles from home, where the people who love them cannot reach them in their final hours. We used to know that, when our time came, we would die in Alston Hospital, surrounded by the people who mattered to us. My own mother did. I was able to be with her at the end because Alston Hospital existed. That is no longer something anyone on this Moor can rely on. And the fear is not abstract: it is what it feels like to know that if something goes wrong tonight, help is three to six hours away.

None of this happened by accident, and none of it happened without warning. When the NHS closed Alston's hospital beds in 2018, it did so only after giving a formal, written undertaking that alternatives would be put in place — in its own words,

including... using residential beds as intermediate beds for health purposes.

That undertaking is the reason Grisedale Croft still has step-down beds at all, and it is the reason this community accepted the loss of its hospital without pursuing its legal challenge further. Closing Grisedale Croft, or reducing it to a token handful of beds, would not be one more difficult decision about one more care home. It would be the final piece of a promise, broken.

The pattern is already familiar. In a five-month snapshot in 2016, before the hospital closure was even confirmed, Alston's minor injuries unit recorded at least 194 patient contacts — a figure the NHS's own data pack acknowledged was likely an undercount. That same August, a staffing crisis had already forced bed closures here, a warning given in real time, in writing. The argument now being made against Grisedale Croft — that a small rural service is a service that can reasonably be let go — was not true of Alston's hospital then, and low occupancy produced by years of under-resourcing is not evidence that it is true of Grisedale Croft now.

Last night, asked directly whether NHS commissioners could be brought into the room to help resolve this, Nikkie, you told the meeting honestly that you could not guarantee it — that it was not within your gift to promise. You are right. It is not within WFC's gift alone. We recognise that much of what has gone wrong here sits with the NHS, and beyond the reach of WFC's Adult Social Care remit on its own. We are also conscious that many of the people now dealing with this may not have been in post when these commitments were first made, and may not have known, until now, how badly things have gone wrong here. We are not writing to lay this at any single door, and we are not writing to blame anyone for what they did not know. But you know now. Jointly, WFC and the NHS can put this right, and only jointly can it be put right. That is exactly why the response has to involve both organisations, in the same room, at the same time, with the authority to act — and that is precisely what has not happened.

Every name on this email holds some share of responsibility for what happens next. A decision deferred in an office in Kendal, Carlisle or Newcastle lands, eventually, on this Moor, in a house at the end of an unlit road, three to six hours from the nearest ambulance, 30 miles from the nearest A&E, on rural roads that are often blocked or weather-restricted. That is not a hypothetical. It happens here, and it could happen tonight.

Alston Moor Parish Council is asking, formally, for a joint meeting: WFC, the North East and North Cumbria Integrated Care Board, the Parish Council and the League of Friends, in one room, with people present who have the authority to decide something. Not another consultation event. Not another drop-in. A meeting that produces a decision, so that this community has the same safety, and the same access to basic care, that people anywhere else in this country can take for granted.

Every person copied into this email can take that for granted. We cannot. We cannot take it for granted if we cut a finger, if we have an accident, or if we simply need an ambulance. We cannot take it for granted if we need step-down care, respite care, or end-of-life care. And increasingly, because of what is happening to Grisedale Croft, we cannot even take basic residential care for granted.

We are not asking you to imagine the consequences of further delay. We are telling you plainly: for a community with ambulance response measured in hours rather than minutes, delay is never neutral. It costs the thing that cannot be recovered afterwards.

We were promised a NHS community hub by the Success Regime with clinics and video consultations, by Cumbria County Council for step down beds, and by the North West Ambulance Service for a full ambulance service. All of those promises have been broken, and our fight to keep our basic services has been dismissed and ignored. People left the meeting last night believing WFC intends to do exactly the same. Our two ward councillors spoke up for us knowing only too well the truth of what I'm saying.

Please hear us.

So we would be grateful for a date, one where all the organisations can be in the room together. And we want to be equally plain about this: Alston Moor Parish Council will not let this matter rest. We will keep writing, keep asking, and keep returning to this case for as long as it takes to see it properly answered — not because we take any pleasure in the correspondence, or indeed the fight, but because in 2018 this community took the NHS at its word and stepped back, and that word was not kept. This time, we intend to stay on this until something is actually delivered, not just promised.