Patients are suffering in pain due to NHS rationing, which is affecting access to community nurses and hip operations, a new report says.
People at the end of their life are being left for hours without pain relief due to nursing shortages, while other patients are denied access to operations for non-clinical reasons, the King's Fund said.
The think tank looked at four areas where rationing has affected patient care - sexual health services, district nursing, planned hip operations and neonatal care.
It said in some areas there is "clear evidence that access to and quality of patient care has suffered".
District nurses support the care of people at home, including those who are housebound, suffering a long-term illness or who are at the end of their life.
The report found services in this area are under "significant financial pressure", with funding either static or reducing, despite rising demand.
The number of district nurses fell by almost half between 2000 and 2014, and fell by a further 15% between 2014 and 2016 for full-time posts.
Some regions have one in five posts unfilled, the study found.
It also warned that patients are also facing tougher scrutiny over whether they qualify for district nursing.
Patients who can attend a GP surgery, even if it is a struggle, are being barred from accessing district nurses, it said.
The King's Fund found evidence that more work is being "deflected" to nurses in GP surgeries, hospices and carers.
There are also long delays in how long it takes district nurses to get to people.
One hospice manager told the King's Fund: "The district nurses working at night are not able to give effective response times.
"You can wait up to eight hours... for patients experiencing pain and discomfort in the last two to three days of their life, it has a massive impact."
Hospices also described a "'tsunami" effect caused by "sparse" end-of-life care, with staff having to step in and do things normally undertaken by district nurses.
Other workers "raised concerns that informal carers are expected to provide an increasing amount of care as services fall away".
There were also reports of staff being rushed and stressed, abrupt, task-focused and having no time to speak to patients.
District nurses are being forced to work "significantly over their contracted hours" and are working very intensely, the report said.
It also said there was a large reliance on the "goodwill" of staff.
On hip replacements, the study found some regions such as York have been restricting access by telling obese people to lose weight.
Others will not operate on smokers, while in other areas patients need to be in unmanageable pain day and night.
The report said such measures are already starting to affect access to care, with the number of hip replacements in 2015/16 falling for only the second time in 16 years.
Waiting times for operations are also rising, meaning some people are left in pain for longer.
The King's Fund also found severe cuts to sexual health funding, despite increasing demand for the services.
Neonatal services are also under pressure.
The report said: "The level of financial pressure on the NHS is severe and shows no signs of easing."
It said there has been a "significant slowdown in funding growth - between 2010/11 and 2014/15, health spending increased by an average of 1.2% a year in real terms, way below the historic annual growth rate of 3.7%.
It added: "The current rate of funding growth is not sufficient to cover growing demand."
Ruth Robertson, lead author of the report, said: "Longer waiting times for hospital treatment and restrictions to operations are just one small part of the picture.
"Our research shows that services like district nursing and sexual health, where we found evidence that access and quality are deteriorating for some patients, have been hardest hit by the financial pressures facing the NHS but that this is often going unseen."
NHS England has written to clinical commissioning groups (CCGs) reminding them not to use "arbitrary cut-offs" for who can and cannot access hip and knee surgery.
Dr Mark Porter, chairman of the British Medical Association (BMA), said: "As this report shows, patients are unfairly suffering the consequences of a deliberately underfunded NHS at breaking point.
"Pressure on all services is rising and care is increasingly being rationed.
"Waiting lists should not be rising, and yet they are."
An NHS England spokesman: "Ultimately these are legally decisions for CCGs, but informed by best evidence and national guidance where appropriate."
A Department of Health spokesman said: "Blanket restrictions on treatment are unacceptable - but the NHS is now doing 5,000 more operations every day compared to 2010, so accusations of inappropriate rationing are misplaced.
"We're investing £10 billion to fund the NHS's own plan for the future, supported by an immediate cash injection of £2 billion for social care and £100 million for A&E to help to improve care in the community and ease the pressure on hospitals."
The NHS England spokesman added: "Actually, as the King's Fund's own report shows, the NHS in England is performing almost double the number of hip operations than it was 15 years ago, and the number of NHS funded hip and knee operations has in fact increased over the past three years, and we expect it to continue to rise."
Copyright (c) Press Association Ltd. 2017, All Rights Reserved.