HEALTH services provided by Skipton General Hospital must be reviewed if Airedale NHS Trust is to meet the stringent financial targets set by the Government, chief executive Bob Allen has argued.

Speaking at the annual general meeting of the trust on Tuesday, he defended the potential closure of Skipton Hospital, saying that "cottage" hospitals had been marked for closure since Airedale was built. And the trust must put the needs of the patient first, not the buildings, he added.

"It may be unpalatable to many people but it is a fact of life that change is inevitable," he said.

"This fact of life has been underlined by the way this Government is going about its business and the health service. The Government are not going to give us money for nothing. They expect us to improve our services and that means confronting painful debates as we are having now in Ilkley and Skipton.

"Some might say we could go about it better and fair enough, but the fact of the matter is we must confront change."

"Airedale General Hospital was built in 1970 to replace the small hospitals up and down the villages, which is often forgotten," he added. "In those small hospitals we were able to provide very friendly, local care and somehow in moving those services to Airedale we have kept that.

"We are still committed to giving care within our communities but what we are about now is deciding what is appropriate. Is it appropriate that all the out-patient clinics should continue?"

He added: "Is it right that we continue to provide the same services in our small hospitals without critically looking at them? We are treating the small hospitals with no less a critical eye than we treat every department in Airedale hospital every year."

Mr Allen said that the trust needed to balance the need for staffing departments which dealt with minor injuries against the need for staffing departments which saved lives.

However in response to a question from Dr Tom Gibson, he agreed that the physical rehabilitation department at Skipton was of great value.

"What we are talking about is appropriate care in appropriate settings, that the facility is in Skipton is incidental," he said.

He said that the move may seem to contradict Government pledges of more money being put into the health services, but those pledges came with a price.

"The Government is committed to putting more money into the health services and Airedale is receiving its fair share, and in the next five years we will probably see a large capital investment in Airedale," Mr Allen added. "They are going to give us a lot more money, but they are not going to give us it for nothing."

Director of finance Janet Crouch outlined the trust's position. She said that the Government had set a series of "must do" targets, all of which had been met. But to continue to meet these targets, the trust had to be efficient.

At the beginning of last year the trust had received additional funding of 7.1 percent, but had to provide a further two percent itself through efficiency savings.

Pay increases for staff, purchase of drugs, increase in capital charges, increase in pension contributions, a forced reduction of junior doctor hours, a climate levy, the working time directive and funding essential developments had eaten up these additional resources, leaving the trust in a deficit of £1.729 million. However one-off funding, largely given as a reward for meeting targets, had balanced the books.

This year, the trust has received a 6.5 percent increase in resources - but again, uncontrollable cost increases such as the above had left a £1.579 million gap which had to be met. Again the trust is expected to make efficiency savings amounting to two percent of turnover.

After the meeting, Mrs Crouch said that in reviewing services provided in Skipton, Ilkley and Bingley, the board was trying to address a deficit that first arose last year, but had been contained. The deficit has rolled forward into this financial year, and it needed to find recurrent savings to ensure that it balanced its books in future without the help of 'one off' allocations.

She said: "National targets must be achieved. We are hung for not achieving those. We are going to have to develop more efficient capacity. We have got to keep reducing waiting times, we have got to become more efficient. We have got to make sure that appropriate services are expanded and improved.

"There are greater expectations, the public have huge expectations of what we are to achieve. They hear the headline figures and think there's a lot of money about, but we must contain our ambitions."

"We want to design services around the patient, not around buildings. We are going to have to major on what we are providing for the patients, not on buildings. We are determined we are going to deliver quality, and it has to be done with the maximum efficiency. We have to make every penny count," she added.