Parts of the NHS in England are undeniably cutting jobs to claw back huge deficits, but there is dispute about how badly frontline services will be affected.
Ms Hewiit insists the NHS is treating more patients than ever
Health secretary Patricia Hewitt insists NHS has just had its best year, but unions say patient care will be severely hit.
ANNE LEEDHAM SMITH, Regional Organiser for the RCN in the East Midlands
The health services continues to provide a very good service but what we are talking about is these deficits and the fact that nurses can't get jobs when they qualify.
In the West Midlands alone, 4,000 nurses will not get jobs this year.
We've had 3,000 jobs lost already in the last few weeks and it is going to continue.
We've known about these deficits for a long time but the government just decided to pull the plug and now we've got this crisis on our hands.
Nobody denies the trusts have got to balance their books, however, we have known about these deficits for four or five years.
What they (the government) should do is slow down. Let's look at these deficits and change it to something like a bank loan so they (the trusts) have to pay it back over 10 years.
These deficits are as a result of a historical position.
For example if you take Worcester, they have had a deficit as a result of the failed building of their hospitals and because of mergers.
It's also been about putting in reforms - trusts haven't got enough money to make them work.
I accept that there are job freezes, but we have got to look at the reality that student nurses who are qualifying this year will not get jobs.
We will have a surfeit of people who are qualified to do a job which they can't do.
In my opinion, that's people going from areas where nurses are particularly needed.
GILL MORGAN, Chief executive of the NHS Confederation
There's always a sort of laziness which assumes that everyone who works in the NHS works in a hospital.
What we've been doing over the last few years is developing more services and systems to allow patients to stay in their own homes.
This must be good because we know that patients want to be in their own homes as long as possible.
Some of the changes are already happening in terms of staff numbers. The largest group that's affected by the changes are administrative and clerical staff.
We have just done a review of all our members trying to identify what's going on.
One of the problems with a time like this is that there's a lot of hot air and figures being bandied around, but none of these figures have an awful lot of evidence to them.
'Not real jobs'
The survey that we have done suggests that the vast majority of posts that
are being lost are not real jobs.
They are jobs that are being filled by agency staff or temporary staff and
they are now being moved out of the system.
The majority of trusts are doing everything they can to actually avoid moving or losing clinical staff.
A skilled an effective work force is really important.
The NHS has already done a tremendous amount over the last year.
We've reduced waiting lists, we have provided new forms of treatment, we are thinking hard about the productivity question.
We are bringing far more patients in on the day of operations rather than keeping them unnecessarily in hospital for a couple of days.
There are real significant changes going on but we have to set that against the fact that for a number of organisations there are significant financial challenges.