The health secretary fought to rebut complaints about service cuts and damage to pensions in his speech to the Royal College of Nursing annual congress.

Andrew Lansley was not booed by delegates, as some had predicted, but his attempts to deny that cuts are being made to staffing and services were met with jeers and laughter at times.

Mr Lansley was questioned several times by nurses about reductions particularly in community nursing, which was highlighted in a report published by the RCN yesterday.

The health secretary denied services were being cut overall because of the drive to make substantial “efficiency savings”, which he backs, because the savings should be reinvested to meet increasing needs.

Mr Lansley said: “You cannot do this by cutting the very things patients need and rely upon.”

In relation to concerns about staffing levels, he told nurses: “If you do have a view that staffing levels literally are not safe for patients I think it is part of your professional responsibility [to highlight that].”

Questioned about his controversial NHS reforms and Health Act Mr Lansley said: “I don’t want to reopen the debate about the act.”

He highlighted the ongoing Prime Minister’s Nursing Care and Quality Forum and said: “Let me hear that voice out of congress about how nurses… can take leadership about improving the quality of care.”

He said poor nursing care was, “an exception but it is an exception we don’t want to ignore, and you don’t want to ignore”. He added: “While many hospitals and community settings do really well, others don’t.”

Among the other issues Mr Lansley was pressed on in questions from delegates were changes to pensions, regional pay and mandatory regulation of healthcare assistants.

He was also asked to given a commitment he would ensure clinical commissioning groups – which are replacing primary care trusts under the reforms – would employ substantive, full time senior nurses, with the same pay as the GPs which will dominate the groups.

Mr Lansley did not give those assurances but said he agreed more nurses needed to be involved in leading the CCGs.

At the end of the speech, RCN general secretary and chief executive Peter Carter told Mr Lansley that his being given a “dignified” reception by delegates was “not an indication that things are fine”. He said: “There is a great deal of unhappiness.”