Here are the facts: This is the future of the NHS as we know it; something must be done to prevent the total demise of our Hospitals & Services as Patrica Hewitt welcomes cuts & the downfall of the NHS....these reforms are crippling the NHS .

The full scale of impending hospital closures was laid bare last night as it emerged that three out of four trusts are already restricting patients' access to treatment as they battle soaring deficits.

Fears about the number of closures intensified as Patricia Hewitt, the Health Secretary, sent NHS managers a guide on how best to handle decisions to shut down hospitals and units - a document that opposition politicians immediately branded a "spin" blueprint.

At the same time, a survey of NHS trust chief executives revealed the impact of the health service's financial crisis on frontline care. The survey, published in today's Health Service Journal, shows that 73 per cent of primary care trusts, which run GP clinics and health centres, are already restricting access to treatments. Half are also delaying operations.

Seven out of 10 chief executives said "patient care will suffer" as a result of short-term financial decisions to cut deficits, while 61 per cent of acute hospital trusts said they were already closing wards.

Almost half of all trusts said that they had made, or intended to make, redundancies this year.

Morale appears to be at rock bottom, with 86 per cent saying that managers were "battered and bruised" by endless reorganisations. Miss Hewitt published her guide on closures amid growing panic in Whitehall about the looming public backlash as trusts across the country announce plans to cut services over the coming months.

But the opposition immediately accused ministers of "a cynical exercise" in spin as it emerged that the guide includes proposals on "media handling" and urges trusts to use words such as "adapting" or "evolving" services when talking about cuts.

Dozens of accident and emergency units, maternity units and community hospitals are facing the threat of being shut down or downgraded as part of the Government's plans to "reconfigure" the health service. Many Labour MPs fear the cutbacks will cost them their seats, prompting four Cabinet ministers to join local protests against planned closures in their own constituencies.

In a covering letter to the guide - which has been sent to all 10 Strategic Health Authorities in England - David Nicholson, the NHS chief executive, said it was vital that managers did not "shy away from major service changes that address financial difficulties".

Miss Hewitt's new blueprint on closures, written by Sir Ian Carruthers, the former chief executive of the NHS, stresses that trust managers must do more to sell their closure plans to local people. The report conceded that closures would "lead to a loss of public confidence" and that reconfiguration had "become a euphemism for closures and downgrading of hospitals". It argued that NHS managers could limit the damage by developing clear media strategies, using the right language and trying to get some senior doctors to back their plans.

Managers are warned that the media can often run "damaging" stories on closure plans. "Effective media handling plans, regular engagement of local journalists, care in explaining the case for change and a strong local voice to challenge misleading media stories that worry patients unnecessarily can help mitigate this," it said. Language is crucial and managers are urged to use words such as "adapting, developing, evolving and specialising. If a service is changing to improve the health outcomes for patients and save lives, this isn't a downgrading of the service."

Managers are also advised to argue that closures will be compensated for by better services in local health centres or GP clinics. The new guide was condemned last night by the Conservatives and Liberal Democrats.

Andrew Lansley, the shadow health secretary, said: "Nothing in this long-winded document will offer any comfort. It is all about advising NHS bureaucracy how it can better sell decisions. It offers no real evidence for how services can and should be improved. "The Department of Health should be less concerned with spin and more concerned with substance."

Norman Lamb, the Liberal Democrat health spokesman, said: "This is a cynical exercise and their cover has been blown. It demonstrates that despite claims that decisions are made locally, everything is driven from the centre. Even the spin is sent down from Whitehall."

Dr Mark Porter, the deputy chairman of the British Medical Association's consultants' committee, said changes in services needed to be about improving patient care.

"The BMA is not opposed to reconfiguration if it is done for good, sound clinical reasons. But we have been worried that finances and not patients' needs have been the driving force behind some plans," he said.