Cutting knee replacements, cosmetic procedures and IVF fertility treatments are among a raft of proposed NHS savings aimed at balancing the books.

NHS Clinical Commissioning Groups (CCGs) across Cheshire and Wirral are working together to ration healthcare because of ‘a rise in demand’ which means West Cheshire CCG is facing a forecast £13m deficit in 2016-/17.

The CCG says it has a ‘legal duty’ to reduce its financial deficit.

However, Labour politicians argue the Tory government is deliberately underfunding the NHS with an agenda to undermine free health care at the point of need to pave the way for privatisation.

Latest proposed cuts on which the public are currently being consulted are:

■ Offer replacement knee ops only to those in ‘severe pain’

■ Restrict surgery for removal of non-cancerous skin lesions

■ Stop funding to correct asymmetrical breasts

■ Reduce IVF fertility treatment for couples struggling to conceive

■ Options to restrict or halt male and female sterilisations

■ Stopping or restricting pain-reducing hip injections

■ Ceasing funding for erectile dysfunction unless due to diabetes or cancer

■ Stopping funding for circumcision on religious and cultural grounds

Dr Andy McAlavey, medical director, NHS West Cheshire Clinical Commissioning Group, said: ‘This is the first time that CCGs in this area have come together to seek the views of the public and stakeholders as we continue with our programme of changes.

"Our aim is to ensure that the services we provide are effective and sustainable whilst we continue to encourage people to lead healthier lives. It is important for us to make the best use of our resources and we are encouraging people to have their say.”

The consultation runs until January 17, 2017. Click here for more details.

Chester Labour MP Chris Matheson believes it’s no coincidence the consultation is taking place across Cheshire and Wirral as he suspects it is designed to largely mirror the footprint of the controversial Sustainability and Transformation Plan (STP) for Cheshire and Merseyside NHS.

A total of 44 STPs have been submitted to NHS England as part of a five-year strategy to slash a projected £22bn funding gap.

The Countess of Chester Hospital

The STP has sparked talk of closing the Countess of Chester Hospital, making patients travel to Wirral for routine operations and the proposed down-grading of A & E at Warrington General Hospital.

STPs will either sound the death knell of the NHS or lead to a modernisation that will ensure its long term survival depending on your view.

Mr Matheson, who recently met Labour’s new Shadow Health Secretary Jon Ashworth MP at the Countess of Chester Hospital, said: “I invited Jon here today to demonstrate to people in Chester how seriously Labour are taking the underhand way in which the government is seeking to reshape our local health services through more cuts and ultimately the privatisation of the NHS.”

Western Cheshire CCG has already decided it will no longer prescribe basic painkillers and gluten-free food as part of cost-cutting measures.

And in November the CCG board agreed in principle that it will no longer perform planned surgery for non-urgent patients until they quit smoking or lose weight for those with a BMI equal or greater than 30 – heavy drinkers could also be excluded unless they reduce their alcohol intake.

One anonymous NHS manager said: “This is rationing of services and will have a big impact on patients and there has been no consultation regarding this significant change with the local public; the CCG are just passing this through.”

Although the agenda does not mention holding a consultation, a report of the meeting states: "The pre-operative medical optimisation objective was agreed in principle by the governing body with a view to rapidly consulting more widely on it and preparing an implementation plan within the next two months.”