BOSSES at Nottingham's hospital trust are used to making tough decisions about services in the face of financial pressures.

The merger of the City Hospital and Queen's Medical Centre in 2006 saw 1,200 jobs cut in a bid to save £60 million.

Since then the merged trust's financial recovery plan has steadied the ship and reduced the need for further job losses.

But a squeeze on public funding means officials are again being forced to find other ways to do more with less.

Though the trust hopes the cuts needed next financial year will not impact on patient care, it admits 400 posts from its 13,000-strong workforce will need to go.

The coalition Government's public spending review in October is expected to mean primary care trusts across the county get less money than they need.

Bodies such as NHS Nottingham City and NHS Notts County get a bill every time a patient goes through the door at the QMC or City Hospital.

But to save money they will now aim to pay for less treatment at Nottingham's hospitals and pay less than previously for the services they do commission.

Nottingham University Hospitals Trust are making £29 million of savings this year (April 2010 to March 2011) as part of the annual efficiency drive demanded by the Government.

But officials said the annual efficiency savings next year could rise to £35 million, and they would need to make between £20 million and £40 million in savings on top of this.

Chief executive Dr Peter Homa said the trust's objective was to "make sure there is no negative impact on the quality of patient care".

He said: "That is tough, but one of the reasons we do the job is to provide the best quality of care for our patients.

"We have worked hard to ensure we have a reasonably sound financial base and our objective is to ensure we improve the quality of services."

The trust also hopes the Better For You scheme, which was started 18 months ago, will make its services cheaper and more efficient.

The project gives staff an opportunity to come up with ideas for improving the way services are provided.

Officials say it has led to savings of £5,000 a year for each ward by cutting waste and making better use of equipment.

Other improvements include speeding up access to scans and X-rays and using new ways of communicating so medics are freed up for patient care.

Staff at the hospital trust were told about the need to reduce its workforce by 400 posts last month. Bosses hope to be able to do this by natural wastage and not filling existing vacancies rather than making people redundancy.

Martin Benn, Unison representative for the hospital trust, said losing the posts would "inevitably have an impact on patient care".

He said: "We are saying there is no more fat to trim from the bone. It will be difficult to lose 400 posts without there being a knock-on impact.

"What they are calling back-room staff are actually front-line support workers. Without domestics and porters and secretaries there will be an impact on patient care."

Glen Swanwick, of the Notts Local Involvement Network, which represents patients, said there was a need to make cuts across public services.

He said: "This is something that we should have been doing years ago, trimming things and not just taking people on.

"We have reached saturation and we have got to make changes without affecting services."

Nottingham's hospital trust gets around £600m a year from primary care trusts (PCTs), which pay for and plan healthcare in Notts and further afield.

The coalition Government has pledged to increase funding for the NHS, but spending plans to be announced in October are expected to leave PCTs with less money than they need. This, combined with increasing demands on the NHS due to an ageing population, means trusts need to be ever more efficient.

In January NHS Notts County revealed it had a £50 million gap in its budget because of the increasing cost of drugs and more patients being treated.

All NHS trusts in the county have come together as part of the Productive Notts scheme to make processes more efficient.