The NHS has shed nearly 15,000 jobs over the past nine months despite the Coalition Government's pledge that health would be protected from its programme of huge public-sector spending cuts.
Dozens of hospitals have shut wards or removed beds – or are planning to do so – while others have announced plans to save millions by scaling back on the services they offer.
Aid agencies are also preparing for a major shortfall in expected government aid over the next two years, even though Britain's aid budget was the only other area that David Cameron promised to exempt from cuts.
The Prime Minister has committed to raising aid spending to 0.7 per cent of gross domestic product by 2013. But senior aid agency sources have told The Independent they suspect spending could be flat-lined over the next two years, meaning cuts in real terms.
Figures collected by the Royal College of Nursing (RCN) call into question the degree to which the health service has been protected from the biggest cuts in generations. They reveal that since the start of the year:
* Queen Mary's Sidcup A&E unit is to be closed from mid-November. From December there will be no birth facilities at the hospital, although antenatal care will continue to be provided
* Southend University Foundation Trust has closed one general medical ward, and plans to close a second ward which caters for elderly patients later this year.
* Gloucestershire Hospitals NHS Trust has revealed it needs to save £27m-£30m this year; 45 beds have been shut so far.
* Nottingham University Healthcare Trust needs to save £29m this year and £35m next. The Trust plans to lose 400 posts through natural wastage.
* University of Leicester NHS Trust has cut 325 jobs, with a further 100 earmarked for closure.
* Portsmouth Hospitals NHS Trust is looking to save £37m this year. Since last October the headcount has fallen by nearly 400.
Ministers have repeatedly promised that the NHS will be protected from budget cuts in this Wednesday's Comprehensive Spending Review (CSR) and will receive a real-terms increase in funds over the next three years.
Managers were recently told to find cuts of up to £20bn over the same period. The cuts are the equivalent to up to 6 per cent of the current NHS budget. They are needed because although health spending will increase marginally in the CSR, the financial demands on the service will far outstrip the extra money available.
Extra demands on the NHS include a mini baby boom and an ageing population. Managers have also been warned that if local councils, as expected, cut back on their social care budget, then hospitals will be forced to look after many more people who would otherwise be cared for at home.
Dr Peter Carter, general secretary of the RCN, said this crisis would dwarf previous recent cutbacks. "We believe that the Government genuinely wants to protect frontline services, but what we are seeing on the ground are thousands of jobs cut, vacancies frozen, staff down-banded and services closed," he said. The NHS Confederation, representing 95 per cent of NHS organisations, said a "potent cocktail of financial pressures" meant the spending rises would not be enough to cover the rapidly rising costs.
"We have got a mini baby boom going on at the same time as the population overall is ageing," said its acting chief executive, Nigel Edwards. "Many of these elderly people have chronic conditions. The NHS drugs bill is rising by around 10 per cent a year but the settlement we are expecting to get from the Treasury is around 1.5 per cent a year."
A Department of Health spokesman said the Government had made a "historic commitment to protect the NHS budget". He added: "The Secretary of State has been very clear that every penny saved will be reinvested back into patient care."
Meanwhile, senior aid agency sources say they have been given signals that aid spending will flat-line over the next two years, rather than increasing regularly to reach the Government's target of spending 0.7 per cent of GDP by 2013. A spokesman for the Department for International Development said he could not comment on the spending plan.
The Justice Department is facing a cut to its budget of almost a third, which could see a reduction in the number of prisoners, huge cuts to legal aid in family-law cases and the closure of courts across Britain. Leaked details suggested Ken Clarke's department would be one of the worst hit.
The Ministry of Defence appears to have won a minor victory by seeing its budget cut slimmed from 10 per cent to 8 per cent. Two new aircraft carriers will be built, but Liam Fox, the Defence Secretary, admitted troop numbers would fall. Reports last night indicate that overall Army troop numbers will be reduced to 95,000, from 102,000.
Treasury sources said last night that major infrastructure projects such as the £16bn Crossrail project, the Mersey Gateway bridge, and the expansion of broadband connections would go ahead.
Local authorities will be given some compensation for the squeeze on their budgets. They are to be handed much greater freedom to decide how to spend the Whitehall grants which make up about 80 per cent of their income.
Danny Alexander, the Liberal Democrat Treasury Chief Secretary, has ordered a switch under which town halls will enjoy flexibility on how they allocate £7bn of central government grants.
Under Labour, the number of Whitehall grants earmarked for specific areas of spending rose from 23 to 91. A Treasury source said that amid inevitable cuts, "these changes will free up local authorities to spend how they want to, not how Whitehall wants. It is one of the biggest acts of decentralisation in recent times."
The week ahead
Today, 11am: Alan Johnson to set out new details of Labour's economic policy
Tomorrow, 3.30pm: David Cameron to reveal results of the Strategic Defence and Security Review
Wednesday, 12.30pm: George Osborne to unveil Spending Review details, including departmental cuts of £83bnReuse content