More than 800,000 people in North Yorkshire rely on services provided by the biggest NHS Trust in the country which its bosses say is coming under “considerable and sustained strain”.
The York York Teaching Hospital NHS Foundation Trust runs 10 hospitals, including Whitby and Scarborough, as well as a range of community services, covering 3,400 square miles.
After delivering tens of millions of pounds in efficiencies since 2009, it must find another £25m in savings this year and next and more after that.
Difficulties with doctor and nurse staffing in the nearest A&E at Scarborough led external experts to note in May that recruitment was “a significant threat for the future”.
The trust is likely to be one of the first in the country to offer recruitment and retention premiums to doctors to work there.
Further shortages of doctors have led to unpopular changes to local eye clinics which have been withdrawn from Whitby and Selby hospitals, leaving patients with further to travel.
Now its financial outlook is worsening significantly, triggering a public warning by chief executive Patrick Crowley.
He added: “If we can’t provide better and more comprehensive services in the community then hospital services will continue to be squeezed at an unaffordable, and increasingly unsafe level.”
“We are facing a significant efficiency requirement in a system that is becoming almost over-cooked and it’s becoming ever more difficult.
“We need to achieve those savings and continue to provide what we have always provided because we don’t have the option to reduce what we do.”
Urgent care centres open around the clock are planned for Scarborough and Ryedale to relieve A&E pressures.
He added: “I think generally if we invest in alternatives to hospital care that will help manage people more sustainably out of hospital and avoid all but the most acute admissions it will give us more space and time to provide the quality of care we aspire to.”