By Nick Triggle Health reporter, BBC News

Thousands have protested against NHS cuts

But only just.

Hospitals may be facing up to the prospect of closing key services, but it is nothing to do with deficits, ministers say.

Instead, Health Secretary Patricia Hewitt and her team have been claiming it is all part of some grand plan.

They point out the government has already set out a vision to move more care into the community so it is only natural the hospitals of the future will need to be smaller.

Health Minister Andy Burnham even said rather than putting the NHS under threat, the events were unfolding to allow the health service to make "one of its biggest leaps forward in its history".

Rally

But, as the hundreds of people who marched through central London and attended a rally a stones throw from Parliament last week shows, not everyone is convinced.

One of the main criticisms is that the extra community services promised are not yet in place.

Among the demonstrators last week were staff and patients from North Staffordshire.

They say the situation there is symbolic of what is happneing elsewhere.

CHANGING TIMES Up to 60 hospitals are expected to carry out reviews which could lead to emergency care being centralised at super regional centres, while general services such as outpatient care are hived off to the community sector The government has pledged �750m over five years for community schemes such home chemotherapy and a new generation of community hospitals Some 3,000 GP premises will be refurbished or replaced by 2008, while 750 multi-disciplinary health centres will open

The University Hospital of North Staffordshire NHS Trust has responded to the mounting �15m deficit by announcing over 1,000 jobs will go along with 160 beds and thousands of outpatient appointments.

The plan put forward by hospital bosses says community services will pick up the slack.

But out in the community, staff and public see it very differently.

One of the key policies in moving care into the community - as set out in a government white paper in January - is practice-based commissioning.

The scheme offers GPs budgets to set up specialist services such as dermatology and asthma clinics - just the sort of services provide on an outpatient basis by many hospitals.

However, Dr Prasad Rao, a local GP, said few doctors had got such schemes up and running yet.

"I just do not see that there will be sufficient services in place to cope with the extra burden. The government needs to invest more."

Struggling

Andy Bentley, of North Staffs NHS SOS campaign group, said: "It is like a double whammy really. We are losing services and staff at the hospitals, while community services are struggling.

"There are no new doctors, nurses or health visitors to take on this extra work, so it will mean the patient suffers."

North Staffordshire PCT, which is in charge of paying for community services, is facing a �1.4m deficit and while it is not large in NHS terms it has meant there has been limited money for investment.

PCTs, especially those with funding deficit, will probably be finding it hard to invest in new services Anna Dixon, of the King's Fund

A spokesman said they had not received any extra money so it had been unable to increase the staff numbers with the exception of two teams of community matrons who were taken on a year ago.

"We have had to start working more innovatively. We have started doing blood tests in the community and things like that."

Alex Nunns, of the Keep Our NHS Public campaign group, believes the government is using the white paper aims as an excuse for the hospital cuts.

"The community services are not in place - and in the cases of many community hospitals are even fighting for their survivial - and yet hospitals are being hit all over the country.

Complaints

"This is going to leave tremendous gaps in patient care."

The Department of Health dismisses such suggestions, pointing out it has already pledged �750m over the next five years for community services from home chemotherapy to a new generation of cottage hospitals - although this money has still not been allocated despite hospitals already being scaled down.

Officials also pointed out 3,000 GP premises will have been replaced or refurbished and 750 new health centres opened by 2008 - through a combination of private and public funding.

Whole communities have been mobilised

A spokesman for the Department of Health added: "The NHS has never witnessed such a sustained investment in community hospitals, modern GP surgeries and one-stop health centres."

But Anna Dixon, deputy director of policy at the King's Fund health think-tank, suggested the critics had some grounds for their complaints.

She said the hospital reviews were not just being driven by deficits as the move to provide care in the community was part of a long-term plan.

But she said there was a "genuine concern" over whether the community services will be in place to cope with the extra burden from hospital reconfigurations.

"PCTs, especially those with funding deficit, will probably be finding it hard to invest in new services.

"There is likely to be a gap between the disinvestment in acute care and the investment in community services."