Up to 500 job cuts have been proposed at hospitals in Hertfordshire in order to help make £18m of savings.
The East and North Herts NHS Trust is looking to cut 10% of its staff.
Managers are also reviewing the number of beds needed at its Lister Hospital, Stevenage, and the Queen Elizabeth II Hospital, Welwyn Garden City.
Union bosses have described the plan as a "devastating blow" to both staff and patients, but health managers said patient care would be unaffected.
The trust, which also runs other health services in Herts, is looking to close the equivalent of two to three wards by September 2006.
"A lot of local people will be angry about this announcement"
The trust said in a statement: "While the trust cannot rule out redundancies, it is hoped that these can be kept to a minimum.
"To support the reduction of up to 500 posts, the trust is also reviewing the number of beds that it needs as it improves clinical efficiency.
"Through improved admission and discharge arrangements, the trust is reducing its average length of stay for patients to best practice for the NHS.
"It is also looking at introducing new initiatives such as 23-hour surgical beds. As these changes take place, it is possible for it to close beds and still maintain high quality care."
Trust chief executive Nick Carver said: "Developments within the local health service in recent weeks mean that the level of cost reduction that the trust has to make this year has all but doubled to £18m.
"While that is out of an overall budget of some £267m, the trust is already pursuing a highly challenging programme of clinical and non-clinical efficiency saving activities."
Redundancy notices
Geoff Reason, from the union Unison, said: "The loss of 500 jobs is a devastating blow to patients and staff.
"This latest announcement comes on top of the trust's decision to send typing services to India. They have issued redundancy notices to all 160 medical secretaries, asking for 58 voluntary redundancies.
"Unison will not take these cuts lying down. A lot of local people will be angry about this announcement and we will be contacting patient's groups, MPs and joining with other unions to build up support against the cuts."
Detailed plans will go before the trust board's meeting on 26 July.
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