As the community in West Cornwall marks the first anniversary of the momentous "March of 20,000" held in Penzance on 14th April 2002, it is time to reflect on what the march achieved. The community demonstration, the largest of its kind in living memory, brought together the widest cross-section of the community in a peaceful but determined illustration of the strength of feeling in the area about the threats posed to its hospital services. The marchers, united under leaders from local government at parish, town, district and county level, the Member of Parliament, the League of Friends and West Cornwall HealthWatch, had unanimously signed up to the seven-point "People's Option" on the future of West Cornwall Hospital:

• A fully manned 24 hour Accident and Emergency Department
• 24 hour medical and surgical emergency admissions under the care of consultants and appropriate Junior/Trust doctor cover
• A wider range of visiting specialists for outpatient and in-patient treatments, particularly paediatrics
• Increased diagnostic tests and therapies with sufficient back up resources such as a CT scanner, access to 24 hour radiology opinion and improved laboratory facilities.
• Improved usage of the mortuary facilities for post-mortems
• Guaranteed, punctual, appropriate transfer of patients to a more appropriate centre when required
• A growth in the services offered by West Cornwall Hospital may necessitate a physical expansion of premises

So, one year later, what has been won for the community? Of the seven points, not one has yet been implemented. Following the March of 20,000, health administrators initially dismissed the views of the community as not understanding the issues. However, the sheer size of the march undoubtedly had an impact, as shortly afterwards the discredited Consultation Document was discarded. A busy round of meetings followed, and the result was a "Pilot Study", still in progress, looking into possible ways of using West Cornwall Hospital. The Pilot Study is overseen by a Steering Group, which comprises eight of the March's leading campaigners, along with eight from the Health Community. The study has attracted significant government funding and is set to last another year or so. None of this would have happened had the March not been such a remarkable success.

However, significantly more has NOT been won. West Cornwall Hospital is not scheduled for any real building expansion; neither have the hoped-for clinics or CT scanner yet materialised (but a second scanner is due to be installed at Treliske in September). Far from decentralising services, it seems that all future acute developments are indeed to be centralised on the Treliske site, as recent health reports reveal. Furthermore, due to apparent doctor shortages, treatment previously offered at Treliske (thoracic surgery) is now being transferred, temporarily in the first instance, to Derriford in Plymouth, as reported at the recent Board meeting. Emergency surgery remains under real threat at West Cornwall Hospital. Indeed, emergency cases may yet be replaced by assessment locally followed by transfer to Truro for in-patient treatment. And senior health officials have dismissed any idea of a second Accident and Emergency Department for the county, despite strong support for this from all quarters including the Cornwall Community Health Council. Whilst we cannot of course pre-judge the outcome of the Pilot Study, we fear that the hoped-for gains may not in fact be realised in West Cornwall.

It is not yet time to take to the streets again. We must allow the Pilot Study to run its course. But now, one year on from that momentous Sunday evening in Penzance, we feel we must give this community a timely reminder that we have not yet won what we all marched for.