TEN years ago, the NHS was on its knees. Patients were lying for days on trolleys in A&E units, waiting more than a year for life-saving as well as routine hospital treatment, and the fabric of many hospitals, mental health units and GP surgeries was crumbling.

A decade on and much has changed. NHS spending in Yorkshire has tripled to £8bn annually. A total of 140,000 people work for the NHS in
the region including 38,000 nurses and 9,000 GPs, consultants and dentists.

Waiting times for hospital care have fallen dramatically and will reach 18 weeks from GP referral to surgery by the end of the year. More modern facilities with better equipment are now treating patients.

But despite the investment, many problems remain firmly entrenched. There are huge disparities in life expectancy. In Sheffield, people living in the affluent suburbs of Dore and Totley can expect to live 14 years longer than people on the deprived Manor estate.

Baby boys born in Bradford are three times more likely to die before their first birthday than those in parts of North Yorkshire.

And there are significant differences in NHS services. Asthmatic children who are patients at some GP practices are twice as likely to need admission to hospital than others, while overall in the region numbers of children needing specialist treatment for the condition are the highest in the country.

Access to mental healthcare remains patchy and is often woeful.

Technology and expertise have also moved on. Doctors can do much more for patients and increasingly specialise as they carry out ever more complicated procedures and treatments.

Against this background, 150 clinicians from across the region yesterday published a report setting out how inequalities in illness and life expectancy can be tackled and how differences in NHS services can be overcome.

More resources will be directed towards community care, where patients, particularly those with chronic long-term conditions like diabetes, heart disease or lung ailments, can expect to have more tests and access to a wider range of services either at their local clinic or at home.

Local hospitals will provide more day-case surgery but – controversially – will lose services as highly specialist care is provided regionally.

Patients with life-threatening emergencies such as strokes and heart attacks may no longer go to their nearest hospitals, while doubts are likely to be cast over the future of some A&E and maternity units.

The NHS has a generally poor record of achieving change. Patients and staff often feel decisions have already been taken before public consultations, amid suspicions services have changed for financial reasons rather than to improve care.

But yesterday's report is unusual in that for the first time changes are being driven by clinicians. They warn services cannot safely be provided in the same way as in the past – although they admit some changes will face opposition from the public.

Prof Chris Welsh, who led the review, said it was the first time in the history of the NHS that clinicians had been asked to drawn up their recommendations on the future shape of the service.

He said decisions about how services are organised were for local people but the review had deliberately not said that all services would remain because it could not make promises that could not be kept.

Services would not look the same in 10 years as today, although he expected district general hospitals would continue to have a "serious role" to play.

"This is not a Government policy-driven change, this is local clinicians saying what needs to happen," he said.

"We cannot go on with the results we are currently getting. Many of them are good but a number are poor and need improving. Some people are getting treatments that are 10 years out of date. They are better than nothing but not as good as they could be.

"We have to really level with the public. If it was explained to them they needed to transfer from their local institution to a specialist centre to get the best outcome they would be prepared to go. But this doesn't mean that local services need to be shut down."