Cutting costs

This, however, does not necessarily mean that the answer lies with the centralised diktats of the Care Quality Commission, the latest in a long line of Government health inspectorates.

Next week, for example, the CQC is expected to impose conditions on the new operating licence for the troubled Scarborough Hospital which will raise understandable concerns among patients.

Under proposed changes to hospital services in the area, heart-attack patients, as well as victims of serious accidents, face travelling for specialist care in larger hospitals some 40 miles away.

There remains a potential risk from such lengthy transfers, and local people will be concerned about the loss of more care from the area despite reassurances about the retention of accident and emergency services, maternity care and other key facilities. This is the type of compromise that will become increasingly common as the NHS has to clamp down on costs and the growing complexity of many treatments means that it is better to provide them in fewer hospitals.

Nevertheless, thought must be given to local needs. The type of rationalisation that makes sense in a large conurbation, for example, is completely unsuitable for the rural areas of North and East Yorkshire. For all the messy compromises being made, the Government's NHS mantra is still that of "patient choice". And few patients would choose to be treated 40 or more miles from their home.