Up to 600 more posts could be closed at Leicester's hospitals as part of a 10-year savings plan.
Chief executive Peter Reading said excellent care would continue
In a report, the University Hospitals of Leicester Trust said up to 200 posts could close from 2009 to 2012 as more services were moved into the community.
The comes after the trust announced 900 posts would be cut over two years as well as 200 expected redundancies.
The trust said more than 1,000 people left the hospitals every year and this was how future savings would be met.
Peter Reading, the trust's chief executive, said: "The plans we unveiled were for what happens to the size and shape of Leicester's hospitals over the next decade.
"We're saying that we will treat 56,000 fewer patients in hospital over the next 3 years, meaning we need fewer beds and therefore fewer staff."
After the original savings announcement on Thursday, union officials said strike action could be a possibility as future care proposals had not been made clear.
"The primary care trust during the course of this year has cut staffing numbers," said Nick Holden from workers' union Unison.
"There are no announcements from the primary care trusts in Leicestershire about additional resources, additional staff or additional services over the next two years.
"They have put a statement out noting UHL's ( University Hospitals of Leicester) decisions but making no promises at all about increasing services in the community," he added.
Mr Reading added savings of £35m had been made across the trust in the last 12 months but a redoubling of effort was necessary for the hospitals to become even more efficient.
The trust runs Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital.
In addition to job losses, wholesale closure of wards would take place, Mr Reading confirmed.