Coalition cuts to the national health service have started to bite hard, and these key areas are the first to suffer
Speech therapy
In January Islington PCT reduced the number of speech therapists working in mainstream schools from five to three.
A five-year-old girl with a serious learning disability is among the victims of cuts to the speech and language therapy service provided by the primary care trust in north London. "Her mother rang me recently, very distressed, because her daughter had gone from having speech therapy sessions weekly to just twice a term," said Dr Rachel Hopkins, the family's GP.
"I was really shocked that such a service for learning-disabled children would be affected by cuts. This is a critical time in the girl's life and speech development. She recently started school and needs to be able to speak so she can communicate and learn; without that her behaviour may deteriorate."
Mental health
Eighty people in Kent with schizophrenia, depression, bipolar disorder and anxiety have lost a service that helped them continue living at home. The "floating support" service run by the charity Rethink closed on 31 March. Rethink's Gabriella Albert said: "We helped people with severe and enduring mental health needs live in their own houses rather than being hospitalised. Without the service they could get trapped in a vicious cycle of mental illness, end up very, very unwell and be admitted to hospital."
Cuts to child and adolescent mental health services in Islington, north London, have already deprived some people of access to family therapy sessions. Birmingham's three PCTs have reduced access to the improving access to psychological therapies scheme, despite such "talking therapies" for the anxious and depressed being a key priority of both the coalition and Labour.
Walk-in centres
Once hailed as an innovation that would be convenient for patients and relieve the pressure on GPs and A&E units, NHS walk-in centres are now being shut or placed under threat in increasing numbers.
Several have gone in London, including one in Canary Wharf. Newcastle Central walk-in centre, based at the city's Jury's Inn hotel, will go later this month, despite treating 19,591 patients last year. Private firm Care UK's contract to run the centre has expired, but £1m annual running costs mean North of Tyne PCT has decided on closure.
Manchester PCT is reviewing its six walk-in centres, while plans to shut two centres in Nottingham have been referred to Health Secretary Andrew Lansley after fierce local opposition. The closure of Oldham walk-in centre between 11pm and 7am, when it usually saw on average four patients, should save the PCT about £528,000 a year.
Elective surgery
Surgery for many non-urgent medical problems is now being stopped, restricted or delayed by growing numbers of PCTs. Such surgery includes operations to remove cataracts, repair hernias, install grommets, replace worn-out hips and knees, remove infected tonsils, varicose veins, bunions or gallstones. Surgery to relieve snoring, and certain dental procedures, for example removal of wisdom teeth, are also affected. Many PCTs say the loss of these, and many other operations, is justified because in most cases they are of low or no clinical value. But medical charities, doctors and surgeons say that denying such treatments can have a serious impact on someone's health and their quality of life. Older people with an arthritic joint can end up staying at home, and relying on others, unless they get a knee hip or knee, for example.
Maternity services
The innovative Enhanced Midwifery Service run by Liverpool Women's Hospital offers "vulnerable" mothers-to-be in deprived areas advice about health issues such as smoking and diet in pregnancy and breastfeeding. But its future is in doubt after Liverpool city council said it would withdraw its 75% funding for the scheme and three maternity support workers did not have their contracts renewed. The postnatal counselling group in Islington for mothers with postnatal depression ended on 31 March when funding was withdrawn. The newly built birth centre at Barking hospital in east London, staffed by midwives and planned to help ease the pressure on local hospital maternity units, has yet to open, though NHS Outer North East London insists it will do so later this year. Similarly, Andover birth centre in Hampshire is "temporarily suspended".
Fertility treatment
At least 11 primary care trusts have suspended altogether or restricted access to IVF, exacerbating the already patchy provision of treatment which can be a couple's last chance to become parents. From this month, East Riding PCT will only fund one cycle of IVF, rather than two. That cut will contribute £150,000 towards its £9.5m savings target.
Prof Stephen Killick, research director of the Hull IVF Clinic, said the move was another example of IVF's "dreadful postcode lottery".
Five other PCTs are reviewing their policies, while four have recently reinstated treatment after previously temporarily suspending it. South West Essex PCT, for example, recently apologised for the "upset and distress" its seven-month denial of IVF until this month had caused.
Dementia
Two care homes in Sheffield that specialise in looking after patients with dementia are under threat after the city's PCT said it was considering withdrawing £2.8m of "top-up" funding for them. Woodland View and Birch Home between them care for 100 residential patients.
The homes are twice as expensive as other care homes providing similar care for people with similar health needs, says the PCT. But campaigns to save them say that other homes deal with less needy patients. A 15,000-strong petition was given to the city's Liberal Democrat-run council last week protesting against the possible closure.
Campaigner Rita Brookes said: "Withdrawing the NHS funding would be devastating. These homes provide specialist care that isn't available elsewhere. Relocating dementia patients increases mortality rates, too."
The PCT will make a final decision in June.
Physiotherapy
NHS physiotherapy services are becoming harder to access in a growing number of places across England. Some patients are receiving fewer sessions, others are facing waits of up to six months and a few are only getting advice rather than any hands-on treatment. Those with serious conditions such as cystic fibrosis, MS, emphysema and chronic bronchitis are among those affected. The medical benefit of physiotherapy for a range of ailments, especially when delivered promptly, is well-established. Phil Gray, chief executive of the Chartered Society of Physiotherapists, says rationing or delaying treatment costs the country as well as patients in pain, as people end up off work for longer than necessary.
Addiction
Patients in Croydon with serious drink and drugs problems will get reduced access to psychiatrists and specialist nurses as a result of the South London and the Maudsley NHS trust remodelling its addiction services to deal with "significant" budget cuts. Addicts will be seen much more often by GPs. One doctor said patients' chances of recovery could be affected by receiving less help from specialists in addiction. A consultation document admitted the changes would produce "anxiety and concern regarding jobs and colleagues both during and after, anxiety and upheaval as we remodel our service, [and] service user concerns regarding changes to treatment". Harvey House, a 16-bed residential alcohol detox and treatment unit run by Lancashire Care NHS Foundation Trust, closed in December.
Cosmetic procedures
Growing numbers of PCTs no longer pay for patients to have minor surgical procedures that are deemed cosmetic rather than clinically necessary, or only do so in "exceptional" cases. Warwickshire PCT, for example, has stopped funding the removal of benign skin lesions, correction of hair loss (alopecia) and male pattern baldness, facial hirsutism treatments, surgery to remove ganglions (lumps), hair transplantation, removal of excess skin from arms, legs and all parts of the body, tattoo removal and treatment of acne scarring.