HEALTH officials last night refused to rule out the spectre of hospital closures as they began a wide-ranging review of services across Teesside.

Health bosses say they are "not ruling anything out" in a drive for greater efficiency.

The scale of the review is bound to lead to speculation about possible hospital closures, particularly when the new regional super hospital in Middlesbrough opens later this summer.

But the more likely outcome of any changes is the concentration of particular clinical specialisms, leading to the closure of services at other sites.

Hospitals in Stockton and Hartlepool would appear to be potentially vulnerable to services being switched to the expanded James Cook Univer-sity Hospital, in Middlesbrough.

This could lead to patients having to travel further for treatment for specific health problems.

Health bosses have warned that the need to improve the quality of treatment by concentrating services will almost inevitably mean sweeping changes.

Details of any proposals will not be known until December when they will be subject to public consultation and scrutiny by new local authority watchdogs.

If the proposals stir up a storm of public opposition the new scrutiny panels could refer them upwards to a health minister for a final decision.

In launching the six-month review, Ken Jarrold, chief executive of County Durham and Tees Valley Strategic Health Authority, said: "This is a very important day for the Health Service on Teesside."

He said "the big issue" for Teesside was the sustainability of hospital services north of the river.

Last year, a mini-review of hospital services recommended that hip and knee patients in Stockton would have to travel to Hartlepool for treatment and Hartlepool cancer patients would travel to Stockton for care.