The shake-up of the NHS is facing further intense criticism. Writing for Channel 4 News, Royal College of Nursing chief executive Dr Peter Carter says frontline staff are being attacked on all sides.

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"I'll cut the deficit, not the NHS" - a clear, concise and straightforward promise, made by the prime minister, in the run up to last year's general election.

Twelve months on from when this slogan started appearing on posters everywhere and we know the reality.

The frontline, the very thing the Government promised to protect, is being attacked from all sides. Just today, the Royal College of Nursing (RCN) revealed that 40,000 posts are earmarked to go in the NHS. We looked at 21 Trusts in England, getting rid of a total of 10,000 posts. Out of this, an astonishing 46 per cent were nursing jobs. The majority were clinical jobs, the very people that patients rely on, every single day.

Who in Whitehall and beyond could possibly justify cuts on this scale? How can they think that the quality of care, standard of treatment and patient experience won't be hit by this approach? Dr Peter Carter

Who in Whitehall and beyond could possibly justify cuts on this scale? How can they think that the quality of care, standard of treatment and patient experience won't be hit by this approach?

We know that the majority of posts won't be lost through redundancy but by "natural wastage". So, when nurses retire, go on maternity leave or change jobs, they aren't replaced. The fact remains however, the work doesn't stop. Patients still need care, families still need support and the NHS still needs nurses. A nurse lost through retirement is still a lost nurse, they need to be replaced.

Channel 4 News special report - NHS Uncovered

The thing that makes all of this so infuriating is that in some parts of the NHS, we know there is huge inefficiency. Vast sums, hundreds of millions in fact, are wasted, because our health service doesn't work as intelligently as it should. As I told RCN congress earlier, we know that half a billion pounds is wasted on the buying of equipment, because the people in charge of the process don't join up and do it together.

Dr Peter Carter, General Secretary and Chief Executive of the Royal College of Nursing.

We know that at least £300m is wasted on drugs that are never used, at least £850m spent on management consultants and another half a billion wasted because the NHS doesn't look after its staff properly.

The Government and others need to listen carefully - it doesn't have to be this way.

We don't need to slash at the frontline, cutting jobs and hitting services. If we tackle the waste in the system, there are billions to be saved, without impacting on a single patient.

Dr Peter Carter is General Secretary & Chief Executive of the Royal College of Nursing.

NHS reform row: Government reponse
Health Minister Simon Burns has insisted that the NHS must make frontline services a "priority", following criticism from nursing leaders.

Mr Burns said RCN data showing that almost 40,000 NHS posts across the UK face being lost over the next three years "flies in the face" of Government workforce data showing a rise in the number of doctors and nurses.

He added that the Government has pledged a real-terms increase of £11.5bn in spending over the next four years in the NHS.

Health Secretary Andrew Lansley will attend this week's RCN conference, holding a Q and A with nurses on Wednesday but will not deliver a speech as he did last year. Instead, Health Minister Anne Milton will speak to delegates.

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