CANCER services and accident and emergency facilities in Worcestershire are at the top of a hit-list of services that could be changed in a bid to cut spending at the county's hospitals by £20m a year.

Independent management consultants - who were brought in by Worcestershire Acute Hospitals NHS Trust in July to try and balance the books - have also flagged up obstetrics, including both gynaecology and paediatrics, medicine and ear, nose and throat for more 'analysis and discussion'.

But Trust chairman Michael O'Riordan said he wanted to make clear that this did not mean these services are inefficient.

"What it does mean is that they have been flagged up as areas where we might be able to work in a more cost-effective way," he said.

"No detailed proposals for changes to any of these services have been drawn up, nor is the list exhaustive - all areas must be scrutinised but quite naturally the major services will be the subject of immediate focus."

Mr O'Riordan added that as what he might call 'big ticket' areas develop, even more intensive discussions are taking place with the appropriate clinical staff and members of the management team.

"This will help us to make sure that the figures we have are as accurate as possible and that we can begin to consider in detail how costs might be brought down," he explained.

"We are making this information widely available now both to our staff and to the public as part of our effort to keep them as fully informed and involved as we are able."

Finnamore Management Consultants are on schedule to complete their review - which aims to reduce spending from £245m to £225m a year - by the end of the month.

An Independent Review Panel, chaired by Professor Michael Clarke, is being set up to provide further impartial scrutiny of any plans put forward, and an internal staff panel is also being established by the Trust as part of wider efforts to engage as many staff as possible in the review.

The analysis and initial stakeholder engagement process should be undertaken from now until the end of September.

This will enable the proposals to be discussed formally during a consultation period to commence in October.

The intention would be to begin implementing changes from early 2006.