THE WEBSITES of NHS primary care trusts are bright and jolly. They feature babies smiling at grandparents, and phrases like “Changing for the Better — Next Steps” and “More care closer to home” . They reduce the font size to mutter hastily about “modified care pathways” and “strategic closures”, but all the same, those who script this stuff are plainly feeling good. Their cyberworld is a far cry from the timeless aches and staggerings of humanity: like Keats’s nightingale, they live apart from the weariness, the fever and the fret of this sad world where palsy shakes a few sad, last grey hairs and men must sit and hear each other groan.

Nor do they reflect the grim visage of the Health Secretary, who this week will rule that “excellence in financial management” comes ahead of mere clinical objectives. From PCT websites you would never guess at the depth, breadth and despair of the NHS recession. Twenty-two years ago, here in rural Suffolk, we had a cottage hospital, GPs who came out by night, an NHS dentist within cycling distance and a maternity home and mental hospital ten miles away. Now those two are shut and sold, out-of-hours illness condemns you to the evasions of NHS Direct (“a nurse will ring in the next hour or two”) and eventually to a tired, cross locum. We have had no dentist for two years, though we are offered a place on a six-month waiting list 40 miles away. Now the primary care trust is axing the last cottage hospitals. I am glad my children are grown up, and very glad we have two cars. Plenty do not. Cities have their problems — observe the London hospital betrayals — but for every 125p spent in urban deprived areas, we receive 80 or 90p. The Amicus union found one Suffolk health visitor had 500 patients under her care. Yet we have an large aged population and many unnoticed rural poor. Local practitioners are excellent and energetic, but the glossy PCT websites look more and more like skeins of stardust thrown over real anxiety and pain.

Yet there is ingenuity and hope at the grassroots, if only government would let it flourish. Communities keep coming up with cracking good ideas, at minimal public cost, to provide what is needed. Two examples stand out. In the small town of Saxmundham, local doctors welcomed the NHS plan of 2000 and after involving everyone from police and firefighters to charities, proposed a one-stop shop for social and NHS services — including a nursery to serve a local pocket of child deprivation — all under one roof. In the NHS magazine, John Hutton, then a Health Minister, said it should be progressed as soon as possible. The primary care trust said it couldn’t afford the rent (whereon the Department of Health hastily removed the article about it from its website) so the community worked out a way to get private money from a commercial provider to cover the rent. But the PCT panicked and said, according to Dr John Havard, the incredulous local GP, that a new building might “raise expectations” and cause “un- met need”. So much for patient choice: they’re afraid that people will sel- fishly choose to be ill, therefore services must be kept awkward and unavailable.

The next proposal was even more daring. In a round of hasty cuts to meet a £40 million deficit, several small hospitals are due to be closed (as are 80 others nationwide) and the heavily used Aldeburgh Cottage Hospital to be reduced by a third. The intention is to abolish “step-down” beds for patients recovering after treatment in the big distant hospitals. These are an immensely valuable service for the elderly, and free up acute beds in the main hospital. The PCT, however, airily says that it is “better” for people to receive care at home — which, when you live alone in a cottage up a track, with a five-hundredth share of a health visitor and no bell to ring if you can’t breathe at 3am, is not convincing.

But here come saviours! The community wants the little hospital; the PCT’s own consultation overwhelmingly proved that, though they staunchly ignored it. So the community — which has already raised hundreds of thousands to support it — proposes to buy the hospital outright. They would issue shares — untradeable, more like a loan note — against the property value. A charitable trust would run it, reserving the right to buy the shares back gradually. It would have a contract with the PCT to provide the beds it still wants; the remaining ones would be used for new services such as dialysis, hospice care and outreach chemotherapy, which would attract income under the new NHS principle of practice-based commissioning by GPs. A decent little hospital would be saved, in a very new Labour spirit of diversity and public-private co-operation, with the more affluent gladly supporting the rest by ethical investment. Which, after all, is how the great Victorian hospitals began.

This daring piece of people-power was mooted at the end of last year and drew some attention. Shareholders stepped up to make an investment without thought of profit. One, a retired director of Crédit Suisse, said: “I consider my capital safe in the bricks and mortar of the hospital . . . more importantly, we can indirectly contribute to the good of the extended community.”

So far, so good. But no official has yet said “yes”, let alone “yes please!”. Watch carefully now: see whether the PCT bureaucrats impede this daring plan because it undermines their desire to show that such hospitals are not necessary, and might raise questions as to why they couldn’t run it properly themselves. See whether the Health Secretary backs it as an example of local responsibility, or whether she pretends not to notice, afraid that a successful small hospital might rock the boat nationally. See whether — if the buyout happens — the new trust gets spitefully loaded with expensive mad regulation on purpose to scupper it. Watch closely. It’s not just about Suffolk.

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