More than 1,400 jobs are set to be slashed from a key city NHS trust.
Sandwell and West Birmingham Hospitals NHS Trust will make the swingeing cuts over the next six years.
The cutbacks will punch a huge hole in the already stretched 7,500 workforce, one worker told the Post.
The trust, formed in 2002, runs City Hospital, in Birmingham, West Bromwich's Sandwell General, Rowley Regis Community Hospital, Birmingham Treatment Centre and Leasowes Intermediate Care Centre.
It is currently developing a new "super hospital" called Midland Metropolitan to serve the 530,000 people living in Sandwell and West Birmingham. It is set to open in 2018.
The trust refused to confirm numbers but said it wanted to chop £80 million from the wage bill.
However, a weekly bulletin to employees from trust chief executive Toby Lewis, seen by the Post, states: "Where there is scope to change, we now need to press ahead and do so.
"In effect, we will address head on how we will improve outcomes for more patients, over the next five years, with around (by 2020) 1,400 fewer posts, and cut infection, improve mortality, better connect the care of people with long term conditions.
"I am not for a moment pretending these are easy issues. I am convinced that, unless we face these issues now, we will sleep-walk into a position in months or years time where we will have to tackle these issues without preparation or forethought.
"Now is precisely the time to do this and an upcoming Care Quality Commission inspection is not a reason to delay.
"If we lack confidence in our basic safety and safety tracking systems, we should neither pass the inspection nor proceed with complex workforce change. Both, in my view, are what we can and must do."
Staff have been left furious that the email containing the bombshell of the cuts begins with a message about a tea, cake and celebration event to mark anniversaries of employees starting work.
The message then goes on to say: "That first paragraph may seem to you at odds with the rest of this message."
A staff member told the Birmingham Post: "Morale is at rock bottom. Our concern is for patients and the ancillary services which rely on the trust.
"This is something the public should know about. We were informed the process will be done gradually but there is real concern among staff."
The desperate bid to save money also includes chopping hot meals - instead of two each day, patients will receive just one.
Statistics underline the trust's huge role in the life of local residents. Over the last 12 months, it has overseen 5,586 births, 564,395 people attended outpatient clinics and 176,496 casualties attended the two A&E departments.
The trust is looking to identify £125 million worth of "efficiencies". It said that two thirds of its £430 million turnover was staffing costs.
The bulk of savings will be made by cutting back on agency and temporary workers and it is hoped large-scale redundancies can be avoided.
A statement confirmed: "Over the next three months, we will be continuing our work to review our workforce to identify where we can make changes and what we can learn from other NHS organisations.
"This period will include the necessary statutory consultation with staff and trade unions as we alter staffing levels in a minority of teams.
"We spend £25 million each year on temporary staff. We have sickness rates of over four per cent. One in ten employees changes role each year.
"These three things provide an opportunity to reduce costs without large-scale redundancies and to improve the quality of care that we provide by creating stable teams."
Mr Lewis added: "Local residents should have confidence that we will be examining proposals for change through the eyes of our patients, mindful of our duties to taxpayers.
"We are proud of the high-quality outcomes we offer and will not jeopardise those.
"We are also proud of our role as a local employer and we will continue to be, in the future, one of the largest local employers in our area.
"Obviously, proposed changes in our workforce or rumours about possible change, create anxiety and that is why we will work quickly to ensure that everyone who works for us knows where they stand."