Health chiefs at Airedale Hospital say cuts may have to be made to some services as the trust embarks on its "riskiest" ever plan.
Directors have drawn up a three-year business plan, running from this year until 2006, which caters for the predicted expansion in areas of national priority such as cancer, coronary heart disease and emergency care.
But they have warned that the programme designed to meet Government waiting list targets will stretch the trust financially, as it already has an underlying deficit of £2.5 million.
Director of planning and marketing Doug Farrow said the only way of achieving the plan would be to identify areas where costs could be cut while ensuring care in the areas of clinical necessity kept pace with demand.
The trust would also have to identify one-off pots of Government funding it could tap into and continue to share any spare capacity with other hospital trusts in West Yorkshire.
Mr Farrow said Airedale and its partners in Airedale Primary Care Trust and Craven, Harrogate and Rural Primary Care Trust, which buy services from the Steeton hospital, have identified 22 areas where cuts could be made.
He said: "The trust has a plan which indicates we will achieve the key NHS targets for 2003-2004 but there is a great deal of risk. There is also a great deal of uncertainty between 2004 and 2006.
"We will have to meet access targets through demand management and modernisation, and we are very reliant on our partner organisations because they will do the lead work.
"In terms of the first two years we will have minimum staff expansion and we are going to have extra challenges with the new EU working time directive."
Mr Farrow added that the trust could recoup cash by selling services where there was some slack to other PCTs.
Finance director Janet Crouch said: "We could recoup £250,000 income but it is also a big risk as we would have to find people who want to provide it, which will put pressure on our staff."
Medical director Dr Paul Godwin voiced concerns about the reliance on private care and claimed that NHS services were not being used to the full.
"There should be an undertaking that no private treatment is taken until the NHS capacity is full," said Dr Godwin.
Mrs Crouch said it was necessary to use private services in areas such as orthopaedics where there was a shortage of provision in the NHS.
l Plans to treat patients diagnosed with the potentially fatal SARS virus have been announced for the district.
Airedale hospital trust has been working with experts in communicable diseases in Bradford to devise a process of diagnosing and treating any cases of the condition, known as severe acute respiratory syndrome.
l The hospital may bid for the new and highly controversial foundation status, according to health chiefs.
The Steeton-based trust has been urged by Government ministers to try and become one of the new breed of foundation hospitals.
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