Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.



The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.



The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.



They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.



Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity.



The crowdfunded group 38 Degrees said the proposals were the first to be revealed under FOI. The doctors’ union, the British Medical Association, which has been frustrated in its attempts to gain information about the CEP through FOI requests, has previously accused NHS bosses of shrouding the process in “totally unacceptable secrecy”.



Leaked proposals from three other areas have already revealed plans including downgrading or closing A&Es and extending waiting time for operations.



Holly Maltby, a campaigner at 38 Degrees, said: “These plans shed light on just how seriously patient care in South Gloucestershire could be affected. They also begin to paint a picture for how services in other areas of England are likely to be hit too – with cancer treatment and children in need affected.”



More than 245,000 people have signed a 38 Degrees petition calling for full public disclosure on each of the 13 regions being forced to make deeper cuts. “The NHS belongs to all of us, so all of us should get a say in any changes to our local services,” said Maltby.



The 13 regions, which are among those expected to record some of the service’s biggest deficits, have been instructed by NHS England and NHS Improvement to “think the unthinkable” to balance the books. Originally they were told to make £500m of savings by March 2018, later reduced to £250m.



The South Gloucestershire CCG is part of the Bristol, North Somerset and South Gloucestershire sustainability and transformation partnership (STP). The South Gloucestershire savings amount to £4.8m, which is roughly a quarter of the £17.2m savings required from the whole STP.



The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.



The president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, said: “The UK has previously been a champion of fair and equitable cost-containment, so secretive decisions on which services to stop providing are both surprising and unacceptable.

“Transparency is essential around what each service costs the taxpayer, what proportion of public monies go to frontline care and what proportion is wasted on the profit margins of non-NHS providers. The public has a right to know the basis on which decisions are made. These should demonstrably be based on principles of equity, efficiency and should include consultation with healthcare staff and the families of children that will be affected.

“Without such transparency there will inevitably be even greater disquiet at the erosion of children’s services at a time when metrics of children’s healthcare in the UK is a recognised cause of national concern.”

An NHS England spokesperson said: “The NHS has always had to live within the budget that parliament allocates and it is grossly unfair if a small number of areas in effect take more than their fair share at the expense of other people’s hospital services, GP care and mental health clinics elsewhere in the country.”

A spokesperson for South Gloucestershire CCG said: “In recent years, health spending in Bristol, North Somerset and South Gloucestershire has exceeded the £1.15bn budget and there is a growing deficit. We have to live within our means to make the best use of taxpayers’ money and ensure there are affordable, high quality health services for our population.

“We have been very open about the requirement to make savings in order to protect services for the long term. Many of the proposed changes will improve patients’ experience of services. Others will have no impact on patients but will improve efficiency within NHS organisations.

“38 Degrees have jumped to conclusions about what the proposals mean. For example, a proposal on cancer diagnostics is about speeding up diagnosis and the process of sending someone for a CT scan – it is not about cutting services. A number of the other proposals they cite were ideas only – and are not being pursued.

“We have given a firm commitment, that where proposals look to deliver services in a different way, specific patient and public involvement programmes will be carried out so that people can be directly involved. That’s why in recent months we have been actively engaging with patients, the public and stakeholders to ask their feedback on proposals to improve services and increase efficiency – all of which is outlined on our websites.”