A HARD-hitting report on North Yorkshire's ambulance service was unveiled this week.

The service has been attacked for focusing more on urban populations than rural communities and for lack of training in some areas.

Other damning criticisms are spelled out in the Commission for Health Improvement study into services at the Tees, East and Yorkshire Ambulance NHS Trust.

While he accepted some of the points, the trust's acting chief executive, Paul Holyoake, dismissed the attack on rural services.

He said a great deal of work had gone into upgrading rural stations and extra staffing and that the service was much improved.

The report said a focus on urban populations has hit the level of services to patients in rural areas.

"Some action has been taken but there is a lack of direction in targeting schemes," the report states.

"Generally we felt the report was well balanced and fair but on this point we were disappointed they came out with that," said Mr Holyoake. "We have put a lot of time, effort and training into rural areas."

He said previously retained stations such as at Bainbridge, Whitby and Pateley Bridge were now on a 24-hour crewed basis.

"A lot of extra staff have had to be put in to achieve this," he said. "Places further down the coast have rapid response teams with paramedics in cars. We refute this aspect of the report."

The report also criticised two-technician crews, a low priority for patient transport, a link-up with West Yorkshire's ambulance service and its subsequent strain on management and said that clinical incidents and risks were not reported.

The CHI's chief executive Peter Homa said: "The trust serves a large and challenging area. There needs to be further direction and progression in many areas and it must ensure it is delivering a fair service to all patients."

Mr Holyoake said some of the issues in the report were already being addressed and that further action would follow the findings.

* Full report: page 16.