The Coalition Government's promise to protect the NHS from cuts was looking increasingly threadbare yesterday as job losses mounted at an accelerating rate.

The Royal College of Nursing (RCN) said almost 27,000 posts were earmarked for cuts, more than three times the number identified last April. Peter Carter, chief executive of the RCN, said the rise demonstrated "how fast this situation is moving" and urged trusts to make a proper assessment of the impact before implementing cuts. "It is two minutes to midnight for the NHS and action to avert a crisis is needed now," he said.

The NHS was awarded a real-terms rise of 0.1 per cent a year in the spending review last month. But £1bn a year of that is to be diverted to social care and up to £300m will go on next year's VAT rise, leaving the NHS facing a real terms cut of 0.5 per cent. In addition, the service needs to find £20bn of savings by 2014 to cope with the costs of an ageing population and medical advances.