NHS waiting lists are growing, more operations are being cancelled and treatment is being rationed in the first signs that a funding crisis is threatening care since the coalition government came to power.
In a worrying development for David Cameron as his Health Secretary, Andrew Lansley, attempts radical reforms while demanding £20bn in efficiency savings, official figures suggest pressure is already mounting in hospitals.
In a party conference speech in 2006, Mr Cameron promised "no more pointless and disruptive reorganisations" and pledged: "The NHS is safe in my hands." But the Prime Minister's claim to be a defender of the NHS could be fatally undermined if the public fear a return to health service chaos seen under the Tories in the early 1990s.
The number of emergency operations cancelled by hospitals in England has risen by a quarter in the past seven months to almost 250. Separate statistics show a rise in the average monthly number of cancellations of routine operations for non-clinical reasons. This rate from April to December was higher than in the previous year at 40 per cent of hospitals. Nineteen trusts cancelled more operations in the nine months to December than in the whole of the previous year.
On Friday, it emerged that Imperial College Healthcare Trust, which runs several hospitals in London, is facing a £40m shortfall in its finances and a backlog of orthopaedic and trauma cases.
Growing numbers of patients are having to wait for more than four hours to be seen in casualty departments, and the proportion who still had no bed four hours after being admitted doubled between April and December.
The Independent on Sunday has also learned that some doctors are rationing contraception to save money, and that child obesity programmes have already been cut back.
The revelations will add to the woes of Mr Lansley as he prepares to face the wrath of the Royal College of Nurses at its annual conference.
Research by the Patients Association suggests that the number of hip replacements being performed has dropped by 3 per cent in the past year. Roswyn Hakesley-Brown, a trustee of the charity, said the figures on cancellations were "deeply worrying".
Christina McAnea, the head of health at Unison, said the cancellations were a direct result of "the government squeeze on NHS funding". She added: "This can leave patients in pain, as well as storing up greater health problems in the future."
Elsewhere in the NHS there is growing evidence that financial pressures are having an impact on medical decisions. Ministers have been warned by Britain's biggest sexual health groups that local health chiefs are not commissioning longer-acting contraceptive methods instead of the Pill or condoms "on cost rather than clinical grounds".
Marie Stopes International and the British Pregnancy Advisory Service warned that the Government's health reforms could lead to a "postcode lottery" of contraception and abortion services in England and Wales.
The Government's commitment to improving children's health is also in doubt as around half of all obesity experts have left their posts in primary care trusts (PCTs). Over the coming months the situation could worsen, with morale plummeting among staff at PCTs and strategic health authorities, which will be scrapped under Mr Lansley's plan to hand GPs the power to commission £80bn of healthcare.
Leading health academics have warned that the Government is unlikely to see through the reforms because they will be hugely disruptive over the next three years and cause political volatility before the 2015 election.
Professor Martin Rowland from Cambridge University, writing in the New England Journal of Medicine, said: "Any benefits from the reforms could take seven to 10 years, and history suggests that governments do not have the patience, nerve or opportunity to see things through the disruption."
Last week Mr Cameron and Nick Clegg were forced to announce a "pause" in the progress of the Health and Social Care Bill. Splits have emerged, with the Liberal Democrats demanding substantial changes, including more public accountability and scrutiny of GPs. The Department of Health, however, has insisted that little will change in the Bill, leading to claims from Labour that the exercise will be little more than a PR stunt.
John Pugh, chairman of the Lib Dem health committee, said ministers must "really take note of what very well-informed objectors have been saying. Any sense that it was just a PR exercise would be rubbing salt into some deep wounds."
Experts have called for public health specialists to be included in each consortium to ensure region-wide problems are tackled and services for rare diseases are not excluded.
There are also concerns that changes to the way doctors and nurses are trained could create staff shortages and variable standards of care in different parts of the country. The British Medical Association said the changes to education and training were "unnecessary", "flawed" and "damaging to patient care".
Rising waiting lists are often the first sign of resources under strain. The NHS Institute for Innovation and Improvement has previously branded the cancellation of operations for non-clinical reasons a "waste of resources and time" which can be "distressing and inconvenient for patients".
Luton and Dunstable Hospital cancelled 234 operations from April to December 2010, compared with only 142 in the previous 12 months, a rise of 65 per cent. The trust blamed a power cut in December.
Derby Hospitals Foundation Trust cancelled 380 operations from April to December, up from 303 in the previous year. A spokesman said the icy weather and winter flu had created a "significant increase" in demand for emergency surgery. Royal Bournemouth and Christchurch Hospitals, which cancelled on average 19 operations a month compared to just nine in 2009-10, cited two incidents of equipment failure.
The Department of Health insisted there was "no excuse for the NHS to let waiting times slip" and said "every penny saved from efficiency saving should be invested back into patient care".
RCN conference: Lansley to face the wrath of hard-pressed nurses
Andrew Lansley risks the sort of treatment meted out to his predecessor Patricia Hewitt this week at the Royal College of Nurses' annual congress.
In his hastily planned appearance, described by the Department of Health as "a listening exercise", he will come face to face with hundreds of angry nurses reeling from new evidence of job cuts, pension losses and the slashing of front-line services.
An RCN survey published today will make it difficult for the Health Secretary to maintain that his reforms will not damage patient care. Almost all nurses surveyed – 95 per cent – said they were working extra hours to compensate for staff shortages, with more than one in five doing so every shift.
One in five of those questioned said that in the past six months they had come to work while feeling too ill to be there. Two-thirds said they were unable to spare the time while working to get a drink of water.
Mr Lansley can expect a barrage of angry and impassioned personal stories from front-line nurses struggling with staff shortages. And this is before his planned wholesale NHS reorganisation and £20bn-worth of savings are implemented. In 2006, Ms Hewitt was booed by health workers for far less radical proposals for NHS reform. Mr Lansley can expect strong criticism of his decision to hand so much power to GPs.
Nurses believe the move ignores the vital role they could play in commissioning patient services. The RCN is also critical of the threats posed to patient care by increased competition.
Howard Catton, the RCN's head of policy, said: "The Government needs an Elvis Presley moment: 'A little less conversation, a little more action please'."
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