Plans to provide complex treatments in large centres as opposed to local hospitals will prove controversial as only one in three people would be prepared to travel more than 20 miles for treatment.

Health chiefs are also expected to examine moves which would see cuts in consultant-led maternity units and more women giving birth at home.

But four in five people surveyed said pregnant women should only face journeys of less than 10 miles for labour.

The poll was carried out in the Yorkshire Post as officials prepare a health blueprint which is expected to trigger a shake-up of services.

They are expected to set out details in the New Year which could include the centralisation of trauma care for seriously injured accident victims as well as smaller numbers of fully-equipped 24-hour accident and emergency units.

The changes come against a background of concern over widening health inequalities which have led to differences in life expectancy of up to 10 years between poorest and richest in Yorkshire.

There is growing speculation that the scale of the changes required will need huge investment which health bosses in the region are likely to sanction amid early signs of significant improvements in NHS finances.

The 21-question survey, which attracted nearly 500 responses, did, however, find that people overwhelmingly supported the idea of larger specialist centres for expert care.

One in eight respondents said the NHS was excellent but one in seven rated it poor or terrible, with most blaming poor management for problems and too little attention to the needs of patients.

One in seven said they had experience of a postcode lottery of care because of where they lived. One in four said they had been affected by financial problems in the NHS.

Despite huge increases in investment in the health service in recent years, a small majority also said they would be prepared to pay more for a better NHS.

Last night there were warnings about changes.

Graham Stuart, Tory MP for Beverley and Holderness, said: "The idea there should be a small number of extremely well equipped specialist centres to treat serious head injury trauma would certainly have widespread public support but if the reality is that ordinary services such as A&E were provided further away, I would question the Government's strategy.

"I remain unconvinced by the risks and the costs of providing more domiciliary care, which I do not believe is evidence- based, particularly in rural areas where the distances are longer, which makes people more isolated.

"The fear is that a care system for vulnerable and ill people that falls down has a lot of risks attached."

Leeds family doctor Richard Vautrey, deputy chairman of the British Medical Association's GP committee, said: "There will come a stage where we need to ask is it better to travel that little bit further with specially trained paramedics or whether people would rather care be provided closer to where they live but be provided by a local team with less facilities and less expertise.

"I know as a GP in Leeds if I have a patient with a heart attack I want them to go straight away to Leeds General Infirmary because I know my patient has a better chance of surviving than in a smaller unit which doesn't have the same facilities."

Ruth Marsden, chairman of the specialist patient forums in the region, said it was clear that any changes would need to be brought in on a case-by-case basis.

If some services were provided further away, investment needed to be made to make sure patients were properly cared for and only following proper discussions with local people.

"A one-size-fits-all approach does not work. In general, it makes sense to provide more first-line services locally but the question is where do you make the cut-off to access specialist services," she said.


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