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Like every Trust in England, the Heart of England NHS Trust has to make savings of 4% each year, for the next four years.

So in preparing for some tough years ahead managers have decided to axe 1,600 jobs.

That's a choice every trust in England will be forced to contemplate if they are to achieve those savings.

But the big question is, can those jobs be cut without hitting front line services?

The Heart of England Trust's chief executive, Mark Newbold, says the job losses should be achievable through natural turnover of staff.

"We have three hospitals so we have a lot of back office and support functions which is the place we preferentially look to bring staff numbers down.

"Management costs, support service costs - that's where we look, not at front line clinical staff."

But the public sector workers union Unison says the cuts amount to losing 20% of the trust's staff and it is only a matter of time before clinical jobs are affected.

Karen Jennings, UNISON Head of Health, said the cuts will mean a cut in the quality of patient care.

"It's only a matter of time before long waiting lists return, and nurses, healthcare assistants and other vital support workers start to disappear from the wards.

"The trust has said it will protect midwives, neonatal nurses, diagnostic radiographers and language therapists, but what about all the other essential staff who are part of the team and are now facing the axe?"

And across the NHS in England jobs are going.

Harsh reality

John Lister, of pressure group Health Emergency, says more than 3,000 job cuts were announced just last week, with more expected to follow.

"The reality is trusts have got to try and live with their new budgets and there are a whole series of pressures on them," he said.

"They have to look at how they get ready for Foundation status (as part of the government's reform package for the NHS in England), there's a financial squeeze: All these pressures are coming together.

"Over the next two months we will see job losses multiplying."

And this is in addition to more than 24,000 jobs which are predicted to go as a result of the government's decision to abolish all 151 primary care trusts and 10 strategic health authorities in England.

A spokesman for the Department of Health said that Foundation Trusts like Heart of England are free to shape their workforce themselves.

"The Government has protected NHS funding with a real terms increase: next year primary care trust allocations are increasing by £2.7bn, an average increase of 3%.

"However, in this challenging financial climate, we need to get the best value from our protected health budget. The NHS needs to cut out waste and reduce bureaucracy. Every penny saved will be reinvested in frontline patient care."

But it is not just the NHS in England that is facing a squeeze.

In Northern Ireland there have been warnings the 4,000 jobs may have to go; in Scotland that figure is nearly 3,800.

Last year, the Welsh Assembly Government set a target for the NHS in Wales to cut 3% of staff each year for 3 years.

Across the UK budgets are being squeezed and jobs are on the line.