Elizabeth Wade, head of commissioning policy for the PCT Network, said:

"It is right that all NHS commissioners are transparent and should follow due process in the way they plan health services.  NHS commissioners should ensure decisions about changes to local services that might reduce or delay access to care are not arbitrary, but are based on careful deliberation of the available evidence and likely impact on patients.  Where there is poor commissioning practice, we should not support it. Nobody wants decisions on patient care taken in an arbitrary fashion purely based on cost.

"We do not believe that arbitrary cost-cutting is endemic. PCT commissioners take very seriously their role in protecting and improving the health of patients. All PCT boards and management teams have senior clinicians who take a lead role in advising how local services should be planned and delivered.

"It is absolutely essential that all NHS patients continue to have access to the highest quality services possible. Patients rightly expect and deserve the best standards of care.

"But with the NHS expected to reduce its spending by £20billion over the next four years while demand for services continues to increase, effective planning is more important than ever before.  This is going to be a big challenge and we must be clear with the public about the difficult job that lies ahead.

"Some of the actions that commissioners might take to manage this situation include reducing access to treatments that offer limited clinical benefit, allowing waiting times to increase very slightly while remaining within the national standard, or putting in place alternative options to existing services which are of high quality, but lower cost. These decisions must be fully transparent, taken on the basis of evidence, and take into account the value treatment offers both patients and the health service. Where any decisions are taken to limit or reduce certain types of treatment it is essential that commissioners and GPs are clear with patients and local communities from the outset about what services are and are not available to them, and how long they can expect to wait for treatment.

"If the Government intends to take action to prevent commissioners being able to take such decisions about local priorities, it must set out clearly how and under what circumstances such action will be taken, and acknowledge the impact this will have on PCTs, and new clinical commissioners' ability to plan services for their communities.

“Changing commissioning structures will not change the financial pressures on the NHS and these difficult decisions are not going to go away. Everyone needs to be clear about this."