Some specialist nurses say they are under threat of losing their jobs or being downgraded because of NHS cutbacks.

The fears have been highlighted in a new survey by the Royal College of Nursing, which found a fifth of the 330 specialist nurses it polled feared redundancy or the downgrading of their post.

Nurse leaders say this financial squeeze 'beggars belief' against a background of an overall NHS budget surplus of around £1.8 billion for 2007/8.

RCN general secretary Peter Carter said: "Specialist nurses are our gold-plated resources who make a huge difference to the lives of their patients.

"The loss of just one of these highly-trained experts will have a disproportionate impact on patients."

Specialist nurses have become integral to care in a number of fields, including rheumatoid arthritis, diabetes, stroke and Parkinson's disease. The RCN and patient groups say these roles need to be protected if the NHS is to improve patient care.

Douglas Smallwood, chief executive of Diabetes UK, said: "These are the very nurses who will be at the centre of the government's plans to deliver care closer to home and yet these same nurses are being treated as soft targets.

"We should be looking at ways to recruit more specialist nurses and keep those already working in the profession."

The survey also found almost half of the nurses (45%) had worked outside their specialist area to cover staff shortages.

"It is absolutely ridiculous that the jobs of specialist nurses could be at risk at a time when the NHS is on track for a £1.8 billion surplus", said Smallwood.

"People with diabetes need specialist care. Diabetes specialist nurses are an integral part of the local diabetes service and play a fundamental role in providing education and support for general practice diabetes care teams. It would be appalling if people with diabetes lost access to their advice, support and skills."

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