Patients are suffering due to rationing of NHS services, a “significant slowdown” in funding, and limited access to community access and hip operations, a new report says.
People at the end of their life are being left for hours without pain relief due to nursing shortages, while other patients are denied access to operations for non-clinical reasons, the King's Fund said.
The rate at which NHS funding traditionally grows year-on-year had also slowed "significantly" in the past seven years, analysts found.
But extra demand for services – with the NHS providing 5,000 more operations every day compared to 2010 – were also adding pressure on the NHS, a government spokesman said.
The health think tank looked at four areas where rationing has affected patient care - sexual health services, district nursing, planned hip operations and neonatal care. It said in some areas there is "clear evidence that access to and quality of patient care has suffered".
District nurses support the care of people at home, including those who are housebound, suffering a long-term illness or who are at the end of their life.
But their numbers fell by almost half between 2000 and 2014, and by a further 15% between 2014 and 2016 for full-time posts. Some regions have one in five posts unfilled, the study found.
The report found services in this area are under "significant financial pressure", with funding either static or reducing, despite rising demand.
There were also reports of staff being rushed and stressed, abrupt, task-focused and having no time to speak to patients. The NHS relies heavily on the "goodwill" of staff, the report said.
The King's Fund also found severe cuts to sexual health funding, despite increasing demand for the services. Neonatal services are also under pressure.
The report said there has been a "significant slowdown in funding growth". Between 2010/11 and 2014/15, health spending increased by an average of 1.2 per cent a year in real terms, way below the historic annual growth rate of 3.7 per cent.
It added: "The current rate of funding growth is not sufficient to cover growing demand."
Ruth Robertson, lead author of the report, said: "Longer waiting times for hospital treatment and restrictions to operations are just one small part of the picture.
"Our research shows that services like district nursing and sexual health, where we found evidence that access and quality are deteriorating for some patients, have been hardest hit by the financial pressures facing the NHS but that this is often going unseen."
A Department of Health spokesman responded: "Blanket restrictions on treatment are unacceptable, but the NHS is now doing 5,000 more operations every day compared to 2010, so accusations of inappropriate rationing are misplaced.
"We're investing £10 billion to fund the NHS's own plan for the future, supported by an immediate cash injection of £2 billion for social care and £100 million for A&E to help to improve care in the community and ease the pressure on hospitals."
NHS England has written to clinical commissioning groups (CCGs) reminding them not to use "arbitrary cut-offs" for who can and cannot access hip and knee surgery.
An NHS England spokesman said: "Ultimately these are legally decisions for CCGs, but informed by best evidence and national guidance where appropriate.
"Actually, as the King's Fund's own report shows, the NHS in England is performing almost double the number of hip operations than it was 15 years ago, and the number of NHS funded hip and knee operations has in fact increased over the past three years, and we expect it to continue to rise."
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