Commenting on the independent review of health services in North Yorkshire and York, chair of the NHS Confederation's Primary Care Trust Network Rural PCTs Forum, Karen Knapton, welcomed its recommendations and said it was important to acknowledge the unique set of challenges that rural health economies face.

She said: "We welcome this report's analysis of the health services in North Yorkshire and York and its acknowledgment that patients in the area enjoy good health outcomes, and are served by generally good health services and a high quality workforce.

"The report's recommendation to move more services into the community so that patient care is in sync with patient need is to be welcomed. Service redesign and the introduction of new technologies, such as telehealth, will play a vital role in addressing many of the challenges of rural health economies.  Without immediate planning to transform the region's unique circumstances, health services in North Yorkshire and York will continue to face financial problems.

"The commission recognises that health systems in rural areas face a unique set of challenges, including transport problems, dispersed and ageing populations, and the ability to recruit staff. These factors need to be fully considered when commissioners are planning, designing and allocating funding for NHS services.

"We fully support the commission's suggestion that the Department of Health and parliament should investigate the impact of extreme rurality on health economies when considering future funding arrangements so that services can remain sustainable in the future.

"It is crucial that the new leaders of the NHS - including clinical commissioning groups, health and wellbeing boards and the NHS Commissioning Board - are equipped to address these challenges in the future. PCT clusters and CCGs need to begin work together now to ensure the corporate memory of local commissioners is not lost."