This report finds that access to and quality of care are both being affected in different ways across the NHS. While public attention tends to focus on high-profile examples of rationing such as restricting access to some types of treatment, the report warns that financial and other pressures are also affecting patient care in ways that go unseen. In an analysis of sexual health services, district nursing, hip replacement and neonatal care, we have found that community and public health services have been hit the hardest, while acute and specialist services have so far been relatively protected.