by Jonathan Morris
BBC News South West
Health trusts in Devon and Cornwall are slashing services as they struggle under a £10.3m debt mountain.
Trusts are attempting to reduce the high cost of agency nurses
Under-used minor injuries units are being cut, cottage hospital beds are being lost and private patients are subsidising NHS services.
Ten of the region's 18 health trusts show debts, six are in surplus and two are breaking even, say latest figures.
Health chiefs say that despite debts, "radical" changes are improving health care and trusts will break even.
South Hams and West Devon PCT: £749,000
Teignbridge PCT: £180,000
East Devon PCT £62,000
West of Cornwall PCT: £25,000
West Country Ambulance NHS Trust: £21,000
Torbay PCT: £15,000
Central Cornwall PCT: £0
North Devon Healthcare NHS Trust: £0
Mid Devon PCT: -£288,000
Cornwall Partnership NHS Trust -£339,000
South Devon Healthcare NHS Trust: -£501,000
Exeter PCT -£729,000
Devon Partnership Trust: -£827,000
Plymouth PCT: -£845,000
Plymouth Hospitals NHS Trust: -£1.004m
North and East Cornwall PCT: -£1.392m
Royal Cornwall Hospitals NHS Trust: -£1.423m
North Devon PCT: -£4.052m
Total deficit: -£10.348m
Source: South West Peninsula Strategic Health Authority
The North Devon Primary Care Trust (PCT), which has the greatest debt of £4.052m, closed minor injuries units at South Molton and Torrington hospitals in January to save money.
It says these units were chosen because they are the least used in north Devon with an average of about eight patients a week.
It closed 21 community hospital beds just before Christmas.
Chief executive Jac Kelly said: "We have not taken these decisions lightly, but it is not acceptable for the PCT to end the year having gone over budget.
"The changes are very small and we are confident we have minimised the impact on patient care by continuing to support patients in their own home."
Other trusts around the region are also hoping to shorten opening times of minor injuries units to save money.
North and East Cornwall PCT, which has debts of £1.392m, is proposing to reduce the opening times of five minor injuries units at Launceston, Liskeard, Bodmin, Stratton and Saltash.
More than 5,000 people have signed a petition demanding the Stratton Unit stays open for 24 hours a day.
Teignbridge PCT has reduced opening times at Dawlish, Teignmouth, Ashburton and Bovey Tracey minor injuries units and increased the opening times at Newton Abbot.
Central Cornwall PCT is consulting on closing 37 beds in three cottage hospitals, which it says will be replaced with more community care.
The South West Peninsula Strategic Health Authority (SHA), the umbrella organisation for all the trusts in the two counties, has ordered all trusts to cut the use of agency nursing staff to save money.
It has also ordered improved booking of out-patients services and better utilisation of equipment.
In December it was revealed that the Royal Cornwall Hospitals Trust was subsidising the cost of running an MRI scanner which diagnoses problems such as cancer, by allowing private patients to use the machine.
The trust, which has been ordered to make savings of £25m in 2005/6, also came under fire last year for telling a surgeon to slow down the number of operations he was carrying out, saying it could only commission services that it could afford.
But the SHA said that the changes were improving services and saving money so all trusts would break even by the end of the financial year in April.
Waiting times for GP referrals to consultants had dropped from 21 weeks in 2003 to 13 weeks now. Accident and emergency waiting times had dropped so that 98% of patients were seen within four hours.
A spokeswoman said: "Patients are seeing changes, but they are also seeing radical improvements."