A Midland hospital boss last night warned that he would not rule out redundancies.
Tom Taylor, chief executive of the Royal Shrewsbury and Telford NHS Trust, has vowed to cut 211 jobs over the next financial year.
These are in addition to the 80 posts which the trust is already on target to have lost by April.
Staff in all sectors have not been replaced this year when they have left, and Mr Taylor said he would continue to keep a tight rein on vacancies.
"The only person who can sign off a vacancy is me," he said. "I am not replacing people right across the board, from consultants to cleaners and catering assistants.
"Next year I'm going to continue in the same way and I've set a target of 211 jobs for next year. I'm trying to achieve it through natural wastage but I haven't ruled out redundancies."
That might happen, he said, if the vacancies occurred in the wrong place. "If they are all nurses, which I can't afford, I might have to do some compulsory redundancies," he said.
The Health Secretary has ordered a team of PricewaterhouseCoopers accountants to carry out a review of the hospitals' finances next month, to discover how savings best can be made. It is one of the 18 hospitals in the country which is being sent one of the 'turnaround' teams from Government.
Mr Taylor, who joined in August last year, has pledged that both A&E departments will remain open despite the deficit.
"I am quite happy that the consultants are coming because I haven't got the management capacity," he said.
"If we do not make the reductions that we need to make now it could be worse in the future."
Mark Pritchard, the Conservative MP for Wrekin, is to meet union officials from Amicus, Unison and the Royal College of Nursing on Monday to discuss the cuts.
A spokeswoman for the Royal College of Nursing said they had been promised that not one nurse would be lost.