After the appointment of Sir Ian Carruthers, reporter Stuart Arnold spoke to Alan Foster – the man in charge of revamping the region’s hospital services ¬– and asked him to explain why it was necessary and the broader plans.

“We have been looking to come up with a three site model for Darlington, North Tees and James Cook as to how we best use the hospitals and we haven’t been able to make as much progress as we would like in terms of agreeing a clinical consensus on services.

“So, we felt a bit of additional help and support and bringing some independence to the process would be advantageous.

“Ian is somebody really experienced, he has worked in the NHS for many years at a senior level, and he is known to me and to the regulator NHS Improvement.

“He is going to review the work already done and help the trusts reach agreement on a clinical blueprint and advise how to implement it.

'Ridiculous' says MP as health chiefs pay ex NHS bigwig to review hospital services

“We have got to keep A&E type services across the three sites, but there will have to some service changes that we consult on because we do have workforce issues and financial challenges which are not going away and getting more critical.

“Some trusts and commissioning groups are overspending and it is manageable at the moment, but this needs to be addressed.

“There is the opportunity with what we are doing within the STP to reduce bureaucracy and overheads by getting the trusts and the CCGs to work together.

“That would save money from the back office stuff which we could put back into frontline care. “Technology can also help deliver some modern healthcare, for instance using joined up care records and common systems across the trusts so they can talk to each other.

“Nobody is going to lose their A&E, but we are looking at the way we deal with urgent emergency care and also frail elderly patients coming into A&E – we need to find a better way of looking after them at home or in the community.

“There will not be an all or nothing solution and we will keep as many services on the three sites as we can.

“We need to look at staffing and how the population is accessing the three hospitals. Already patients go to different hospitals for different things

“A&E is staying at Darlington, but all services are under review and nothing is guaranteed forever.

“We are looking at a different way of delivering care, for instance where patients now go to James Cook for specialist stuff, there may have to be a bit more of that in the future.

“The tradition of going in an emergency into Darlington, James Cook or North Tees will remain, but it is about the scale of things.

“Some things are more life threatening than others. Already people with major head injuries and trauma go straight to James Cook and there may have to be other conditions that we may need to look at to get a better outcome and a safer service for patients.

“There will be some things that we have to consult on with the public and that is the right and proper process. We aren’t trying to do anything by the back door.

“People are passionate about their hospitals quite clearly and quite rightly so.

“In the past we have had hospitals competing with each other and tendering for services, we are trying to take that away and get true collaboration at the forefront of what we do.

“Competition was okay for its time in driving down waiting times, but we now need to collaborate more fully to get the best out of the local health pound.

“One of the criticisms before was that we were just looking at services within the hospitals, but some local provision could be provided by GPs and community services.

“Clinicians do tend to want to centralise everything because they can see it provides the safest care, but that does not chime with the public and we have to take patient safety into account.

“There is a balance to be struck between how much can continue to be provided locally in terms of the standards of treatment people expect and the ability to call upon the most experienced clinicians if necessary.

“We have also got a finite pot of money and limited resources in terms of people because for some services, for example cancer, radiology, we have not got enough specialists.

“Can we rotate people and use them differently across the three sites to keep as much as local possible?

“It is not easy, which is why this is taking some time, and it is about exploring all the possibilities.

“It is about getting people to the right place at the right time and joining up all the pieces.

“There is some new money coming for the NHS and a ten year plan coming so we need to try and conclude this by November at the latest.”