Hundreds of jobs are to go at NHS hospitals in Worcestershire.
Worcestershire Royal Hospital is one of the hospitals affected
The 720 positions are being axed in an attempt to balance the books at Worcestershire Acute Hospitals NHS Trust, which needs to save £30m.
One in seven staff at the county's three hospitals will be lost. The news was announced at a conference held by the trust on Thursday afternoon.
It runs the Worcestershire Royal, in Worcester, the Alexandra, in Redditch, and Kidderminster Hospital sites.
Trust chairman Michael O'Riordan said: "It looks as if we have ended 2005/6 with an overspend of around £5.5m which is very disappointing.
"But far more serious is a massive and unprecedented shortfall between what we expect to get paid in 2006/7 and what we know it would cost us to provide our services in the way we currently do."
The job losses proposal is subject to consultation with staff and is expected to save the trust about £8m this financial year and £16m in the next one, starting April 2007.
The trust now employs 4,500 staff and has frozen more than 100 posts, which will count towards the 720 jobs to go.
There have been long-standing campaigns to retain services at Redditch and Kidderminster against plans to centralise them at the largest site in Worcester.
There is talk of closure of a ward at the Worcester, but the trust said there are no details yet of where jobs will be lost.
Chief executive John Rostill said: "We will of course work in partnership with union representatives to ensure that any reductions in the workforce are handled sensitively and managed properly."
Mr Rostill added: "We are not complaining about the level of funding we receive, but I need to make it crystal clear why we are in this position.
"Taking on hundreds of extra staff, paying many of those staff more money, treating more patients, more quickly, with more expensive drugs and equipment - and doing all that on three separate sites - is where the money has gone."
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The trust has taken on more than 1,000 extra staff - including 130 doctors and 500 nurses - since it was created in 2000.
Mr Rostill said the trust hit a target of having no patients waiting more than 15 months in 2002. And the maximum wait fell to 12 months in 2003, and again to a maximum wait of nine months in 2004.
He said: "By the end of 2005, waiting times for elective operations were down to a maximum of six months, with the majority of patients being treated far more quickly than that.
"While these waiting times were falling, each year we were also dealing with ever-increasing numbers of emergency patients coming in through A&E - and making sure they were treated and admitted or sent home more quickly."
He said national changes to pay and conditions, meant that pay costs have "spiralled upwards".
Mr O'Riordan added: "Anyone who follows the news will know that we are not alone in our plight, but that is no consolation."
Mid Worcestershire MP Peter Luff said: "In the run-up to the 2005 election, the government frantically drove the NHS to meet over-ambitious political targets - and told trust managers to use every accounting trick in the book to conceal the scale of the financial problems this would inevitably create.
"After the election, the new secretary of state demanded an immediate return to financial balance, causing the current crisis."