Bosses of Birmingham's Good Hope Hospital have pledged not to sack frontline staff in a bid to claw back up to £47.5 million debts.
Chief executive Mark Gold-man told 100 anxious staff and residents at a public meeting that job losses were 'inevitable' - but it would be management that would be affected.
Mr Goldman, who also manages Heartlands and Solihull hospitals, said he planned to keep services in Sutton Coldfield and not make patients travel to the other side of the city for treatment.
He added that opthalmology, stroke, cancer and rehabilitation services in the Sheldon Unit were all safe but would be moved when the building was knocked down to save money.
He also expected to see more patients treated at home or in the community rather than in hospital, even though extra cash is not being made avail-able for this move.
But he said all the plans depended on how much financial help Birmingham and Black Country Strategic Health Authority were willing to offer Good Hope.
"It is inevitable, when bringing two organisations together, we will not need as many staff," said Mr Goldman.
"We will need the same people on the wards at all hospitals, but we will need less in management, the heads and middle management. It won't affect the people directly treating patients."
At least 80 jobs and trust board positions are on the line to help create savings of £3.3 million a year.
Union representative Ray Salmon, from Unison, hit out at management job losses and said: "The best thing about the NHS is the staff.
"Everyone is working to full capacity and when you take people out, even managers, it all falls down as other people have to pick up their work."
The meeting at Fellowship Hall, in Sutton Coldfield, aimed to calm public fears over G ood Hope's spiralling finances, but was greeted with mixed responses.
Patient Paul Davis, from Erdington, a former member of North Birmingham Community Health Council, said: "This meeting has increased my fears and I think the Government needs to intervene with funding aid."