Hundreds of hospital jobs are being axed by a West Midlands health trust.
Sandwell Hospital in West Bromwich is one of the sites run by the trust
Sandwell and West Birmingham Hospitals NHS Trust is to shed up to 800 jobs at its three Birmingham and Black Country sites, it said at a budget meeting.
The trust, which runs City, Sandwell and Rowley Regis hospitals, aims to save up to £20m in the next year.
The cuts are the latest in a series of job losses in English hospitals, which began with up to 1,000 being cut in neighbouring Staffordshire in March.
Sandwell and West Birmingham Hospitals NHS Trust has an annual budget of £308m, more than 7,000 staff and serves a population of 500,000.
Its budget will fall to £303m in the next financial year and a £3m debt has to be repaid. It said expenditure on staff rose from £180m in 2003/4 to £217m last year.
Chief executive John Adler said: "I acknowledge that these changes will cause anxiety to our staff but we have a duty to make the very best use of taxpayers' money to live within our means.
"The idea is that patients don't notice anything but I think it's a little bit rash to say that patients will notice no change at all.
"What I have said is that our basic commitment is to maintain waiting times, maintain the volume of patients that we're treating and to meet all the standards that we get measured against by the healthcare commission."
UNDER THE TRUST
City Hospital, Birmingham: made up of City Hospital, Midland Eye Centre, Birmingham Skin Centre - 700 beds, 3,800 staff and £117m annual budget
Rowley Regis Hospital: 72 intensive rehabilitation beds, including stroke, orthopaedic and general specialties, and 24 beds for continuing care and respite care
Sandwell Hospital, West Bromwich: 557 beds for general medicine, surgery, urology, plastic surgery, orthopaedics, gastroenterology, rheumatology, cardiology, maternity and paediatrics, with a new £18m Emergency Services Centre
The trust said a vacancy freeze has been imposed and staff will be asked if they wish to be considered for voluntary redundancy or early retirement.
Anne Leedham Smith, regional director of the Royal College of Nursing in the West Midlands, told BBC Radio Five Live: "We know that they are going to go to the strategic health authority bank to ask for £5m, so this is completely finance driven.
"We [won't] know the details till Tuesday which is dreadful for the staff because that means they've got to go through the whole of Easter without knowing what's in store for them."
Also speaking on Five Live, Unison representative Esther Lowe said: "I have to say that this morning has been quite disappointing and we've got some major concerns over the announcement that was made.
"Unison cover a whole spectrum of staff within that 7,000 at City and Sandwell and our members are domestics, catering staff, estate staff, medical secretaries and I think unfortunately it will be these groups that perhaps suffer in all of this"
The trust had a "cost reduction programme" last year which saw £10m saved with 200 lost posts, but said this only involved one compulsory redundancy
Other job losses have been announced in the region at hospitals in Staffordshire, Nuneaton and across Worcestershire.
Nationally, some 7,000 jobs losses have been announced at English hospitals in the past few weeks.