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Royal College of Nursing study reveals that most job losses involve frontline staff as patient services are withdrawn Growing numbers of patients are being denied treatment for conditions such as loss of sight, arthritis and infertility as the NHS increasingly rations healthcare in order to save money, research by the Guardian shows. Services for patients with mental health problems and addictions and those who need physiotherapy after accidents are being scaled back, while operations to fix hernias or remove cataracts or varicose veins are either being refused or delayed. The cuts across England cast serious doubt over David Cameron and Health Secretary Andrew Lansley’s repeated pledges that NHS frontline services will be protected from budget-tightening across the rest of the public sector. There is further fresh evidence of cutbacks in the NHS in a dossier of evidence compiled by the Royal College of Nursing (RCN), which gathers on Monday for its annual congress in Liverpool. Meanwhile, the British Medical Association claimed that ministers are refusing to acknowledge an “accelerating withdrawal of services” that could weaken patients’ support for the NHS. “While there’s an absolute crisis going on in the NHS in terms of this accelerating withdrawal of services, you have got a government that through the health and social care bill currently going through parliament simply wants to discuss the finer points of the business organisation of the NHS and denies that this crisis is taking place,” said Dr Mark Porter, chairman of the BMA’s hospital consultants committee. “The examples [of cuts] are becoming more and more widespread. The national picture is that every primary care trust is taking steps to reduce access to whole swaths of healthcare, while the government says everything is fine and that its organisational changes to the NHS are what matter,” said Porter. While the cuts do not affect conditions such as cancer, refusing treatment for other conditions meant pain or discomfort for those affected, Porter added. “For the patient waiting for IVF, speech therapy or a new hip or knee, that’s their contact with the NHS. For them to be told that they aren’t a priority for the health service is totally at variance with the government’s mantra that, for patients, ‘No decision will be made about me without me.’” Growing numbers of NHS walk-in centres, intended to relieve overworked GPs surgeries and A&E departments, are closing or having their opening hours cut. In Islington, north London, services for children with speech problems have been reduced and a support group for women with postnatal depression axed altogether. Primary care trusts all over England are having to reduce their services or provide them in new ways, as they struggle to contribute to the £20bn savings drive imposed by the health service chief executive, Sir David Nicholson. Many PCTs are banning, restricting or imposing long waiting times on treatments that until recently were provided routinely by the NHS. More than half of the thousands of job losses in the health service are nurses, doctors and midwives rather than managers and administrative staff, the RCN has claimed. It has identified 40,000 jobs that have gone or are due to go in the near future as PCTs, hospitals and other NHS organisations across the UK adjust to flat or reduced budgets after years of big year-on-year increases under Labour and, in England, a series of other financial pressures. In a study of almost 10,000 job losses at 21 trusts, the majority (54%) turned out to be frontline clinical staff, the nurses’ union said. That revelation, and the disappearance of NHS services, expose coalition pledges to be protecting NHS frontline patient care and treatment as a myth, the RCN said. “Clinical staff are the lifeblood of the NHS and it is haemorrhaging at an alarming rate. Cutting thousands of frontline doctors and nurses could have a catastrophic impact on patient safety and care,” said Dr Peter Carter, the RCN’s chief executive and general secretary. Whole areas of patient services are being closed or decommissioned, the RCN added, citing Stockport PCT’s closure of family nurse partnerships and, in Birmingham, “talking therapies” for people with anxiety and depression disappearing. “Patients aren’t getting access to the same care they did a year ago. We know that savings need to be made but cutting frontline staff and services is not the way to do it. We are seeing services that may disappear for ever. We are concerned that the result will be patients left in limbo, fewer services, fewer nurses and a worse NHS,” added Carter. Nicholson and the health department said the NHS’s need to meet the £20bn target was no reason for limiting or abandoning treatment. “There is no excuse to cut back on services that patients need when the NHS will receive an extra £11.5bn of funding,” said Nicholson. “The NHS does need to become more efficient, but savings must not impact adversely on patient care. We are clear that every penny saved from efficiencies will be reinvested in patient services. We also have 2,677 more nurses now than we did in 2009.” The health department added: “The government is getting rid of bureaucracy and clinically unjustified targets so that nurses are freed up to do what they do best – taking care of patients. We are also protecting the NHS, ploughing in an extra £11.5bn of funding.” But senior NHS figures are worried that some PCTs are responding to the need for greater efficiency by scaling back services, sometimes dramatically, for example by using “referral management systems” – panels of doctors and managers examining requests for treatment – to bar many patients from receiving care. There is concern among health ministers that the growing cuts could add to their political difficulties over the NHS. Labour claimed the cuts proved that improvements in the NHS had stalled under the coalition. “The government’s obsession with reorganisation is piling extra pressure on the health service. Patients are starting to see the NHS going backwards again under the Tories with waiting times rising, frontline nursing jobs cut and services cut back,” said John Healey, the shadow health secretary. “This is not what people expected when David Cameron promised to ‘protect’ the NHS. The prime minister made health his most personal pledge, but it’s now becoming his biggest broken promise.” NHS Health Public sector cuts Public services policy Public finance Health policy Denis Campbell guardian.co.uk