Ministers are determined that front line services should be protected and the savings needed can be found from management costs and efficiencies.

But there is growing evidence that NHS managers are sacrificing patient care instead.

Doctors and nurses said the ‘grim’ results undermine the ‘myth’ that front line services are being protected and warned they were just the ‘tip of the iceberg’.

The situation is predicted to get worse as the NHS struggles to save £20bn over the next four years.

Although ministers have pledged to protect the health service budget and provide a real terms increase, it will not be sufficient to keep pace with growing demand and increasing costs.

In addition from April next year the amount of money hospitals receive for each type of treatment will be cut by 1.5 per cent raising fears that managers will refuse to provide treatments that they make a loss on.

As part of the investigation, The Telegraph had responses from almost one in three primary care trusts.

Cuts were uncovered in 20 out of the 145 primary care trusts in England. Fifteen PCTs have said they are not cutting services and 11 were still undecided.

[…]Dr Mark Porter, Chairman of the British Medical Association’s Consultants Committee, said: “Each of these examples undermines the myth that the NHS has been protected from the financial crisis. These are all services that patients value.

“They are by and large not being axed for clinical reasons, but as an inevitable consequence of the massive cost savings that have been imposed on the NHS.

“Despite the continuing claims of real terms increases for the NHS, the reality on the ground is very different. The scale of the financial challenge facing the service is such that this is likely to be the tip of the iceberg.

Making health care “free” for patients and preventing people and businesses from making a profit on providing health care leads to higher demand and lower supply. The net result is a shortage. It’s the law of economics.