According to figures collated by the Royal College of Nursing (RCN), 15,000 jobs have been lost in the National Health Service, and several hospital wards closed or severely reduced services since the start of the year.

Emergency budgets were being drawn up prior to May’s general election, after Labour claimed that the recession would force a freeze in health spending. With a funding shortfall of £20 billion, 10 strategic health authorities (SHAs) began putting in place plans for large-scale job losses, ward closures and reductions in the availability of certain treatments.

This was despite a pledge by all the official parties to “ring-fence” health care from austerity measures that they all agreed were necessary. At the time Labour claimed that the shortfall would be met by “efficiency savings”, rather than cuts in front-line provision. But in March, the Telegraph revealed an internal document was being circulated within the South East Coast SHA setting out secret preparations for cutbacks in key services. The document stated, “The new financial environment demands that the trend in workforce growth must be reversed”, and that employee numbers must be cut 10 percent “or further”. It warned that staffing in hospital, “can be expected to decline faster and further” than elsewhere.

This is confirmed by the RCN’s figures, and other reports. In addition to the sizeable job losses already implemented, the cutbacks include:

* Closing the Accident and Emergency unit at Queen Mary’s, Sidcup, from mid-November and removing birth facilities at the hospital from December.
* A reduction of 45 beds by Gloucestershire Hospitals NHS Trust, with more expected as part of its £30 million savings plan.
* The closure of one general medical ward by the Southend University Foundation Trust, with plans to shut an elderly care ward.
* Cuts in staffing by nearly 400 at Portsmouth Hospital NHS Trust, and 325 jobs at the University of Leicester NHS Trust. Nottingham University Healthcare Trust intends to lose 400 posts as a nearly £60 million cuts package over the next two years.

Many other cuts are going through, and there are reports of treatments being withdrawn. According to one Sheffield doctor cited in the Telegraph, for example, it was reported that the city’s health authority has said it will only pay for treatment to manage patients in chronic pain in “exceptional circumstances”.

These reductions are underway prior to today’s unveiling of the Conservative/Liberal Democrat government’s Comprehensive Spending Review. The coalition had pledged to exempt the £100 billion annual budget for the NHS—one-fifth of public spending—from its austerity package, and said health care would even receive an increase in funds over the next three years. But the “increase”, which reportedly amounts to just £1 billion in real terms, will not be enough to fund the rising costs of drugs and growing health problems. The Guardian reported that the NHS is expected to do “more with less”. It cites instances in which hospital wards have been closed for weeks at a time to save money, and consultants complaining that “trusts are withholding cash for operations that are ‘medically necessary’”.

One-fifth of NHS trusts in England admit to closing or considering the closure of key services, such as Accident and Emergency: “A government health insider told the Guardian that it was envisaged that in the coming years ‘a fifth of everything the NHS does today will stop’”.

With local authorities looking to reduce their spending, major cuts in social care budgets—such as provision for the elderly and district nursing—are expected. The burden will fall on the NHS, placing facilities and staff under even greater pressure.

In addition, the coalition is significantly expanding the privatisation and “marketisation” of health care. Its white paper, “Liberating the NHS”, published in July, set out plans to abolish SHA’s and all 152 health care trusts by 2013. The health care trusts currently manage 80 percent of the NHS budget and are responsible for commissioning services, such as general practitioners (GPs), hospitals, mental health facilities and local clinics. Their place is to be taken by “consortiums” of GPs in England who will take over control of budgets directly.

Shadow consortia are already being put in place, with plans for GPs to “buy” services for patients from the best, i.e., cheapest, provider. Two consortia have recently signed deals with NHS Cambridgeshire to take over the majority of local health commissioning. The measures are not confined to the usual GP services. NHS Hertfordshire has signed a deal for a GP consortia to take control of acute hospital budgets.

The white paper also set out plans to turn hospitals into “social enterprises”. Under this proposal, the cap on private income is to be removed while hospitals are to be turned into “employee-led” bodies, like the retailer John Lewis, a mutual company, part-owned by its staff. The company is among a number of private businesses brought in by the government to advise on “new generation public sector organisations”.

On Monday the first 12 Pathfinder Mutuals were announced, to be run “by entrepreneurial public sector staff, who want to take control of their services”. Under the scheme, “innovative” and “entrepreneurial” staff will be given a “stake” in service provision, including control over budgets. An indication of the direction which the “pathfinders” intend to blaze was given by the BBC. Giving nursing staff a stake in the NHS could prove “complicated to achieve”, it stated. “For one thing, hospitals have considerable assets, such as buildings, which are owned by the state and would need to be bought”.