The government should take “a more active interest” in ensuring that patient care is not being rationed, a report suggests.

The Department of Health has “no way” of getting assurances from local healthcare commissioners that patient care is not being restricted, according to the National Audit Office.

While the department has made clear blanket bans on procedures are not permitted, it still needs to develop ways of getting assurances that procedures are not being inappropriately restricted, according to the report.

There was public outcry when it emerged that some trusts had put restrictions on operations, including knee and hip replacements, cataracts surgery and tonsillectomies, to cut costs.

The report, which is examining the efficiency drive in the health service, states: “The aim is to control demand without inappropriately restricting patients’ access to care, but the department has no way of routinely gaining assurance that this is being achieved.”

The authors added: “The department should take a more active interest in demand management and develop ways of gaining routine assurance that patients’ access to healthcare is not being inappropriately restricted.

“Monitoring access is not straightforward but the department needs more evidence on the impact of demand management.

“It should also ensure that local policies on access to care are transparent so that commissioners can be held to account.”

A Department of Health spokesman said: “We have been absolutely clear that rationing services on the basis of cost alone is completely unacceptable.

“Decisions on treatments, including suitability for surgery, should be made by clinical experts taking the needs of each patient into account.

“We have already written to the NHS to set out clearly that access to services should not be restricted on the basis of cost.”

The report also states that it is “not clear” whether the unprecedented savings made in the health service are sustainable over time.

The NHS has been charged with making £20bn in efficiency savings by 2015.

While the health service made £5.8bn in its efficiency drive in the last year, £520 million were one-off cuts, the report states.

It also says that there is “limited assurance” that all the reported savings were actually achieved.

Amyas Morse, head of the NAO, said: “The NHS has made a good start in making substantial efficiency savings in the first year of the four-year period when it needs to achieve savings of up to £20 billion.

“To build on these savings and keep pace with the growing demand for healthcare, it will need to change the way health services are provided, and to do so more quickly.”

Health minister Lord Howe added: “The NHS is doing well to meet its efficiency savings.

“However, if it is to meet the needs of an ageing population, it needs to seriously look at how it can improve how care is being provided, particularly to older patients and those with long-term conditions.

“The NHS must reinvest up to £20bn into the frontline by 2015 if we are to meet the challenges of an ageing population.”

John Appleby, chief economist at The King’s Fund, said: “This report echoes our own work which shows that the NHS has so far made good progress in meeting current savings targets but has a significant challenge ahead if it is to deliver £20bn in productivity gains by 2015.

“However, the extent to which this is delivering genuine productivity gains remains unclear.

“As the report notes, efficiencies will become harder to deliver, as one-off savings such as cuts in management costs start to slow, and much will depend on whether pay increases continue to be restrained.”

NHS Confederation chief executive Mike Farrar said: “The overall surplus for the NHS masks some of the major financial difficulties which some organisations are facing and many of the savings have been made through short-term solutions.

“So, the focus on delivering further efficiencies now needs to move to a whole-system approach.

“Changes must happen across the whole system and it’s good to hear the NAO confirm its view that service transformation - such as investing more in primary and community services - is essential to delivering sustainable efficiency savings in the future.”

Royal College of Nursing chief executive and general secretary Peter Carter added: “It is clear from this report and our own evidence that the NHS is facing an uphill battle to continue making savings on this scale.

“We know many trusts are making ill thought through short-term cuts to jobs and services, as well as benefiting from the pay freeze, to achieve these savings.

“This is not only jeopardising patient care but is not sustainable in the long-term.”