HEALTH service managers in North Yorkshire are putting a brave face on NHS mergers that have left the area with one "super-trust".

As part of a nationwide cull that saw the number of primary care trusts fall from 303 to 152, North Yorkshire's four trusts have become a single unit.

The move went ahead despite fears that replacing four PCTs by a large trust extending from Richmond to York would remove decision-making about health services from local people.

The Hambleton and Richmondshire trust has its headquarters in Thirsk, and the decision leaves the staff there facing an uncertain future.

However, chief executive Simon Kirk stressed the NHS would still try to remain locallyfocused.

"We are very proud of the strong focus on locality-working, which we have worked hard to develop in Hambleton and Richmondshire over the last four years, " said Mr Kirk.

"In the proposed new North Yorkshire and York PCT, this locality focus will be maintained, with local GPs working together to commission health care for patients, and patients continuing to benefit from local services provided by local staff."

At the same time, said Mr Kirk, the enlarged trust would have the ability to deliver better value for money through greater purchasing power and lower administrative costs."

Health Secretary Patricia Hewitt, said: "The new PCTs will be better organised to commission services that best suit the needs of their local population."

A key theme in the reforms, which aim to save £250m in administrative costs, is to align more closely the new trusts with local authority boundaries.

It is hoped patients will benefit from better co-ordinated working between the NHS and social services.

But the new North Yorkshire trust will inherit a collective debt of 36m from the four existing trusts: Craven, Harrogate and Rural District (debt £1.9m) Hambleton and Richmondshire (£4m) Scarborough and Whitby (£6.4m) York and Selby (£23.7m) In County Durham, the Government has decided to form a single large County Durham trust out of the existing Durham Dales, Sedgefield, Derwentside, Easington and Durham and Chester-le-Street PCTs.

But it stopped short of including Darlington PCT in the super trust.

Plans to merge Hartlepool PCT with trusts in Middlesbrough, Stockton, and Redcar and Cleveland have also been dropped.

In a separate move the Government confirmed that two new ambulance trusts would be set up across the region.

A new ambulance trust covering the whole of Yorkshire and Humberside will take in North Yorkshire.

The existing North-East Ambulance Service which covers County Durham, Tyneside and Wearside will be extended to include all of Teesside.