Exclusive: Hospitals targeted in £1bn savings squeeze

The cuts, mainly from 2011-14, will see the longest and deepest period of austerity in the NHS since it was founded 60 years ago.

Early projections in Yorkshire show hospitals will be the biggest losers, prompting warnings last night of opposition if controversial cuts and changes are imposed on patients.

Cash savings will be invested in providing care more cheaply at home or in the community, in landmark changes forced by the public spending squeeze.

Among other radical plans being considered by health chiefs, red tape could be cut by merging back-office functions with other public services including councils and universities, while mergers could take place of NHS-run services and social care provided by local authorities.

Detailed plans, including job losses likely to run into many thousands, are yet to be drawn up but early projections from primary care trusts (PCTs) seen by the Yorkshire Post show:

n 130m in productivity savings are needed over the next four years in North Yorkshire;

n Health chiefs in Bradford are planning savings of 100m-150m by 2014;

n In Kirklees, managers require 75m in savings from the area's two hospital trusts;

n Warnings of a 105m financial black hole in the East Riding by 2013-14 unless savings are made;

n A total of 86m will be stripped out from the NHS in Wakefield over four years;

n Health chiefs in Hull plan to slash hospital spending by 10 per cent from 208m this year to 188m by 2013-14.

Both Labour and the Tories claim they will maintain or even increase NHS budgets despite other cuts in public spending.

But the NHS is planning for only one per cent rises in spending from next year – a real-term cut when inflation is taken into account – and increased demand for care which will put extra pressure on budgets.

The chief executive of National Voices, a coalition of 200 health and social care charities, Jeremy Taylor, said he was not against reductions in hospital services if alternative care was available to patients nearer home.

But there were risks patients' interests would be sidelined as cuts were implemented and he urged health chiefs to give them a role in decision making.

"The NHS is not very good at engaging with the public and heaps a lot of problems on itself as a consequence," he said.

"If you're not open with people, the default assumption is of cost-cutting when often what is going on is far-reaching thinking about improving the quality of care for people."

The director of policy at the NHS Confederation, Nigel Edwards, representing NHS trusts, said money would have to go further and work harder as care was shifted out of hospital into the community.

"It will be very tough and some organisations will struggle," he said. "This is one of the hardest challenges the healthcare system has had to cope with."

Health chiefs in Bradford describe the coming years as an "unprecedented challenge". They plan to cut visits to A&E and emergency hospital admissions and slash costs of bureaucracy in a review of support office functions with Bradford Council and Bradford University.

In Kirklees, officials say opportunities for local hospitals to find efficiencies "appear to be massive".

The biggest challenges are likely to be faced in Leeds but health chiefs refused to provide details of their plans amid predictions hospitals in the city will need to make savings of 40m each year for four years from 2010.