TODAY The Press can reveal details of the strongest warning yet from health leaders on the impact of drastic cost cuts that are being made to local NHS care.

We have seen an internal email which has been circulated to doctors by a York Hospital consultant, after a meeting between medics and North Yorkshire and York Primary Care Trust (PCT) this week.

The email details the doctors' grave concerns about a "seismic change" in local health care and "potential dangers to patients" as NHS managers attempt to claw back millions in debt.

It said: "with this degree of poor planning and hoping for the best with such an acute service - it approaches criminal negligence."

The PCT is this year planning up to £48 million in savings to health care after it inherited huge debts from previous organisations.

York Hospital has been forced to make its own health cuts because of a drop in income of £4 million from the cash-strapped PCT - axing 95 beds and losing 200 jobs.

Hospital leaders have warned that one of the major impacts of the changes will be that there may no longer be beds for all emergency patients who are sent to its wards as urgent, but not life-threatening cases.

It is estimated seven people a day might find closed doors at Wigginton Road from next month - which will mean they are likely to have to go to another hospital.

The PCT has said it is putting alternative services in place so fewer patients have to go to hospital in the first place.

But the hospital email has outlined serious concerns by doctors that the PCT had not effectively planned how these would work.

It said: "I and everyone else were pretty shocked to hear just how badly the PCT has planned this reduction - 3,000 patients a year - in acute admissions."

The fears included:

* There was no contingency plan for when the hospital was full, and ambulance crews had not agreed plans with Accident and Emergency medics on which patients were safe to transport longer distances.

* There were no immediate plans to increase long stay community beds.

* GPs would have an increased workload because more emergency patients would be managed in the community.

* The hospital was already full - and the reduction in funding and beds would increase inefficiency.

* Every year there was an increase in emergency hospital admissions of eight per cent.

Dr Pat Grann, a Selby GP and former chairman of the North Yorkshire Local Medical Committee, said doctors were "very worried" about the fact emergency patients would now find themselves turned away from York Hospital - and there were apparently no concrete plans for how to treat them.

He said: "I can understand the concerns - there doesn't seem to be any forward plan. The problem is that when a doctor is seeing a particular patient, that patient is the most important patient they have got at that moment - it will compromise patient care if you cannot make a safe and appropriate hospital referral.

"Patients are being denied access to the acute trusts - but there's no back-up as far as I can see.

Hospital doctors and GPs feel very strongly about the same things.

"We work together and our working relationship is being jeopardised."


Consultant's email warning

...with this degree of poor planning and hoping for the best with such an acute service - it approaches criminal negligence.

I know to a large degree the trust management has its hands tied and they almost have a gun to their heads to agree proposals with the PCT commissioners.

I'm not sure we clinicians have done enough to let the community of York know just how bad an effect this seismic change is going to have and potential dangers to the patients.


Trust's key care priorities

THE PCT recently announced a 59-page service modernisation plan detailing how it would make huge savings in health care this year.

A spokesman said: "We have been working with clinicians and managers as part of our on-going service modernisation work, which focuses on developing more community-based care and new care pathways for patients.

"The modernisation plans form the backbone of our commitment to deliver enhanced care by offering patients the chance to be treated in their own home where clinically safe to do so, and will also help to restore financial balance for the PCT. Our service modernisation programme is wide-ranging and involves services across the whole of North Yorkshire as well as all of the hospital trusts in our area.

"Certain elements of the work will always be in continuous development. We cannot stand still in terms of the way we deliver services if we are to meet patients' needs and expectations in the future - no change is not an option for us.

"The key priority for us is to deliver the best care we can which is why we are continuing to work closely with colleagues from York Hospital, and others in the local health community, to develop this programme."