Up to 20,000 doctors and nurses may be cut as NHS feels the pain

Clegg's chief adviser threatens to quit as study reveals toll set to hit front-line jobs

Controversial plans to reform the NHS suffered a double blow yesterday after a member of the Government threatened to resign over the proposals and new figures suggested up to 20,000 medical and nursing jobs could be lost as a result of cutbacks.

Norman Lamb, the chief political adviser to Nick Clegg and a government whip, said patient care could suffer because of the speed at which the changes were being introduced. "I've said that if it's impossible for me to carry on in my position I will step down," he said. "I don't want to cause embarrassment but I feel very strongly about this issue... It would be a crying shame if we rush the reform process and got it wrong."

The Royal College of Nursing (RCN), which is holding its annual congress this week in Liverpool, released new figures yesterday suggesting that more than 50 per cent of the planned jobs losses in the NHS will be clinical. So far the RCN has identified more than 40,000 NHS posts due to be lost over the next three years.

But in a survey of 21 NHS trusts, which between them are planning to cut nearly 10,000 jobs, the RCN discovered that 54 per cent were filled by clinical staff. The union said some roles were being downgraded. The Liverpool Women's Hospital Trust is planning to cut 65 specialist nurse posts while introducing 48 staff nurse posts within its neonatal specialty. In Coventry and Warwickshire, managers are planning to reduce the number of registered nurses within learning disability services and increase the number of healthcare assistants.

Dr Peter Carter, the chief executive of 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."

Critics of the Government's health reforms, such as Mr Lamb, believe that at a time when the NHS is being asked to make savings of £20bn it is dangerous to attempt to abolish the Primary Care Trusts (PCTs) that control NHS spending and pass power over to untested GP consortiums within just two years. They would rather the reforms were delayed and scaled back.

Speaking on the BBC's Politics Show, Mr Lamb said: "Change is necessary. For all those that care passionately about the NHS, we've got to recognise that with health costs rising every year because of an ageing population we have to make the money go further. My real concern is the financial risk of doing it too quickly because then you lose services and patient care suffers... We've got to get this right."

Mr Lamb – a former Liberal Democrat health spokesman – said he had discussed his planned comments in advance with Mr Clegg. "I've discussed it with Nick and I feel that having shadowed health for three and a half years, I know quite a lot about the subject and I just feel it's important, now we've got this pause, to give my views on how the Government can get through this."

Downing Street said it was "relaxed" about Mr Lamb's comments and that it was all part of David Cameron's promise to pause, reflect and improve on the Health Bill currently going through Parliament. But sources close to the Health Secretary, Andrew Lansley, said Mr Lamb was guilty of "hypocrisy".

One said: "It was Liberal Democrat policy to get rid of PCTs in the first place. Norman Lamb was intimately involved in drawing up the Coalition agreement and for him now to come out and say he opposes the policy is pure hypocrisy." Mr Lansley is thought to feel increasingly isolated within the Government, having been forced to make an unprecedented parliamentary statement last week to "listen and engage" with critics of his reform.

Mr Cameron and Mr Lansley will co-host another public engagement event on Wednesday with representatives of the voluntary sector before Mr Lansley goes on to attend the RCN congress in the afternoon.

David Nicholson, the head of the NHS, said it was wrong to suggest that posts being lost had anything to do with the reforms. "It is wrong to say there are cuts to the NHS budget. We want to ensure that we deliver high-quality care for all patients and have been clear that every penny saved from efficiencies will be reinvested in patient services," he said. But Dr Carter said the reforms were being brought in too fast. "We have never seen any [reforms] as big as these or as fast as these. To do this while stripping out £20bn, this is a recipe for real instability and it will be patients who will suffer."

The shadow chancellor, Ed Balls, called Mr Lamb's comments "very significant". He said: "Clearly Norman is very close to Nick Clegg, he's his closest political and parliamentary adviser. He made a very important point, which is that we shouldn't see reform as always good. These are bad reforms. What we don't want is a pause or a PR initiative. What we want is the Government to say, 'We got this wrong'."

Clinical jobs under threat

* Country Durham and Darlington NHS Foundation Trust is undertaking a £60m cost-cutting exercise by 2014 and losing 300 nursing posts

* Kent and Medway NHS and Social Care Partnership Trust is proposing to reduce their nursing, midwifery and health visitor workforce by 264 between 2010-2015, a 15 per cent reduction

* Kingston Hospital NHS Trust are losing 214 nursing posts out of a total of 486 workforce cuts

Basildon and Thurrock NHS trust is facing a £20m budget cut and is cutting 218 posts, of which 107 are nurses and midwives

* Mid Yorkshire NHS Trust has placed 131 clinical staff in an "at risk" pool out of 431.

* Barnet and Chase Farm needs to make savings of £8 million and are looking to cut 61 clinical posts out of 149 potential job cuts.