Sickly state of NHS finances

So the revelation that services are to be axed in North Yorkshire

because of ballooning debts will add greater weight to claims of financial mismanagement in the health sector.

The way North Yorkshire and York Primary Care Trust has allowed itself to slip deeper and deeper into the red – its debt stands at 17m and is on course to hit 29m – is extremely worrying.

The health service enjoyed unprecedented increases in spending during Labour's years of largesse so it is a major concern that North Yorkshire has been hit by spending crises.

Now that the trust is being forced to cut frontline services, including the end of IVF treatment for childless couples and the stopping of minor surgery in GPs' practices, patients will wonder what type of service they can expect in the future years of austerity.

Decisive action was needed to halt the slide but how did the trust get into such a mess?

North Yorkshire's health services are the worst funded in the region because of formulas which see cash go to areas of greatest health need, but the economy has been in dire straits for two years and managers have failed to embed cost-cutting ahead of years of financial pain.

The Government may have a role in easing the area's financial plight if it changes NHS funding allocations – perhaps to recognise the different demands facing rural areas and the ageing population. It is clear, however, that there have been deep-seated problems in the way North Yorkshire's NHS is organised in the last decade. These must be tackled urgently

In future, Ministers want GPs to take charge of NHS spending decisions. Whether doctors have the answer to solving the county's financial problems is unclear but it seems likely that fewer people will be going to hospital and more will, instead, be treated in the community.

In the short-term, there can only be more cuts ahead, despite

Ministers' pledge to ring-fence NHS budgets.

Patients in North Yorkshire will not be the only ones to suffer.