Bradford’s health and social care services face a funding shortfall of a staggering £364 million over the next five years, health bosses have warned.

And one health board member has said the district faces some “really hard” decisions, including possible hospital restructures, as it tries to balance the books.

The major cash shortfall would be caused by a range of factors, including shrinking public service budgets, the ageing population and the rising cost of new medical technology.

And this is despite a controversial Council decision earlier this year to tighten the eligibility criteria for access to home care for the elderly and disabled.

To demonstrate the sheer scale of the efficiencies still needed, that decision to raise the threshold for care was only expected to save Bradford Council £1.57 million a year.

The remaining shortfall was revealed at a private briefing for members of the Bradford and Airedale Health and Wellbeing Board.

After the briefing, board member Councillor Ralph Berry (Lab) said other parts of the country would be in a similar situation.

He said: “Nonetheless, it’s quite a gap isn’t it?”

Fellow board member Simon Cooke (Con) said the time had come to explore the options for major changes to the local health system, no matter how unpopular they might be.

He said: “If we don’t do something today then we will be short of money in five years’ time. We have got to be honest with ourselves, because some of these decisions are going to be really hard.”

He said it was the board’s job to take a wider, long-term look at the local health and care system to see what was working and what wasn’t.

He said: “Do we need two A&E departments? I know what people in Keighley would say, which is that they still need one.

“Do we have too many GP practices? There are lots of questions I don’t have the answers to.”

Coun Cooke added that he didn’t think the closure of an A&E department was particularly likely.

He said: “I use that because it is a fairly stark example. In terms of substantial changes, it could well be in the next three to five years that there will be a need to review hospital provision in the district.”

Javed Khan, chairman of the patients’ group Healthwatch Bradford and District and a member of the board, acknowledged that “radical changes” were needed, but said it was crucial that the public was fully consulted about them.

He said: “Those making decisions must engage with people and listen to their experiences, views and needs when planning the radical changes to the health and social care system that are required.”

Mr Khan called for the most vulnerable to be protected as far as possible.

Councillor David Green, leader of Bradford Council and chairman of the health board, said the district’s three local NHS Clinical Commissioning Groups had previously warned of efficiencies needed of around £250m to £300m over the next five years, but further work on the financial modelling had revealed the figure of £364m.

He said: “The challenge for the Health and Wellbeing Board is to ensure that there is a sustainable health and social care system for the future and that public funds available to the whole system are spent on the right priorities for the district.”

Bridget Fletcher, chief executive at Airedale NHS Foundation Trust, said Steeton’s Airedale Hospital was due to open a new emergency department in the autumn, which would “provide the emergency care our patients need now and in the future”.

She said: “We are working with partners across the district to look at our priorities going forward and consider what we can do differently in the future to transform health and social care and improve quality and outcomes for our local community.

“We are also working with technology partners to look at innovative ways to support patients closer to home and close the gap between primary, community, social and secondary care.”

Bradford Teaching Hospitals declined to comment.

Over the coming years, the board wants to encourage the public to take more responsibility for their own health needs and it is also expected to focus more resources on preventative measures, to try to keep people healthier for longer.

It is currently working on its five-year strategy, which is expected to go before the board shortly.