The Royal College of Nursing’s chief executive and general secretary has warned the NHS faces its “toughest year”, with specialist nurses losing their jobs and vulnerable patients “in the firing line”.

In an interview with HSJ’s sister title Nursing Times, Peter Carter predicted most trusts would make “false economies” by cutting the number of nursing specialists involved in areas such as diabetes or breast care.

“Just cutting the post of the last nurse that retired isn’t very intelligent. A diabetic liaison nurse keeps people out of hospital, they prevent complications, they save their salary time and time again. That’s the sort of post we are seeing cut,” he said.

Referring to NHS chief executive Sir David Nicholson’s target for £20bn savings over four years, he added: “A majority of trusts aren’t thinking this through properly. They are caught like rabbits in the headlights of the Nicholson challenge.”

He predicted many trusts would slash their total expenditure by up to 9 per cent in 2012-13 after making non-recurrent savings this year.

“I believe next year is going to be the toughest year yet in the history of the NHS,” he said.

mental health, along with the elderly and learning difficulties, are three services which are right in the firing line as part of the cuts.”

Mr Carter predicted advances made since the introduction of the national service framework for mental health in 1999 would be “compromised” due to cuts in early intervention and outreach services.

He feared this would lead to a repeat of the 1990s which saw a “fairly constant stream of inquiries reporting into homicides and suicides and care in the community was blamed”.

“I can see a re-emergence of problems like suicides,” Mr Carter said. “I’m worried that the short term thinking behind cutting these teams will set up problems.”

Mr Carter said a shift in resources away from the acute sector was justified as “40% per cent of patients don’t need to be in hospital at any given time”.