A Midland health trust is looking to make savings of £15 million so it can continue providing "safe and affordable" care.
Worcestershire Acute Hospitals NHS Trust, which retained its one-star performance rating from the Healthcare Commission despite its financial failings, managed to break even financially in March 2005.
However trust chairman Michael O'Riordan believes the savings are needed to avoid having to find an extra £20 million in 2006/07 to bridge the gap between what it costs to provide hospital services and the funds available.
Mr O'Riordan added the review would be " characterised by openness, transparency and a willingness to listen to what people had to say."
He said: "The financial challenges facing Worcestershire Acute Hospitals NHS Trust are well known. They have been the subject of extensive discussion and comment in recent years.
"Despite many people outside the trust claiming it was impossible, last year saw a remarkable turnaround when we broke even.
"While this was undoubtedly a tribute to the hard work and determination of staff across all three hospitals, it was only the first stage of a three-year recovery plan.
"We face a bigger challenge in balancing the books this year, and a greater challenge still in 2007/08 and beyond as we strive to achieve sustainable financial balance in an ever-changing environment."
The chairman said the short term financial aid the trust had received would end in two years' time.
But Mr O'Riordan claimed it would not break even in 2007/08 unless the trust received additional funds or cut spending on services.
He said: "We will only break even this year if we can achieve a £15 million cost improvement programme and receive the expected support from outside Worcestershire.
"To break even in 2006/7 we either need to obtain extra funding or, like any other organisation where costs exceed income, steps have to be taken to reduce expenditure. We have embarked on a major clinical service review to identify the future size and shape of safe, affordable, high quality secondary care services."