Almost 200 nursing jobs are to be axed at a Midland hospital trust in a bid to plug a £20 million financial black hole.

In a move described as "catastrophic" by union leaders, seven per cent of the total number of nurses' posts at Sandwell and West Birmingham Hospitals NHS Trust will be cut.

The job losses are among 566 positions going - which also includes doctors, administrators and managers - and trust bosses yesterday warned further job reductions would be announced.

A union leader last night described the cuts as "catastrophic" and claimed patients would suffer, while Birmingham's Conservative MP Andrew Mitchell said it demonstrated the Government had "completely lost it" on the National Health Service.

Of the 566 jobs set to go, 430 are currently vacant and will be abolished. Staff in the remaining 136 positions were yesterday told their jobs were at risk, but they will have to wait a further month before they know if they are to be made redundant.

Judith Whalley, convenor for all the unions represented at the trust and a steward for the Royal College of Nursing, said: "Our concern is that we will continue to provide the same level of service to patients, but we seriously doubt that the staff will be able to maintain that as there are already closures of wards.

"This could affect waiting lists because we can't get patients in as fast. You may have to wait longer when you get into A&E.

"It is catastrophic. Any job losses in the NHS are bad because it is about the ability to provide a service.

"Staff are extremely upset. They are distraught. To be told you are at risk and keep them in suspense for a month and then expect them to carry on with their work is untenable."

West Birmingham Hospitals NHS Trust, which runs Birmingham's City Hospital and Sandwell General Hospital in West Bromwich, said up to 800 jobs would have to go in April in a bid to balance the books by the end of the year.

The actual number turned out less because average salaries of affected posts turned out to be higher than anticipated, the trust said.

Chief executive John Adler explained: "This is a very difficult time for the trust. Being made redundant is not easy and we hope that the measures we have put in place will help those who are affected.

"I am pleased that by freezing vacancies we have been able to keep the potential number of redundancies to 136 and I am confident that total will fall once the outcome of the voluntary redundancies and early retirements is known."

Mr Adler insisted the cuts were vital to secure a long-term future, but Andrew Mitchell, MP for Sutton Coldfield, claimed the cutbacks were testimony to the Government's mismanagement of the NHS.

"This dreadful news shows that the NHS is in a state of crisis. After all the additional taxpayers' money which Labour has invested how is it possible that 566 people including 179 nurses could lose their jobs in this way?"

The loss of more than 3,400 frontline and support roles has been announced across the Midlands in recent months.

They are the result of a Government drive to eradicate a £512 million deficit within the NHS.

The job losses at City Hospital and Sandwell General Hospital will include 13 doctors and 173 administrators.

Highly-paid managers, however, are the hardest hit proportionally, with 63 posts to go reducing the managerial headcount by 20 per cent.

Ann Leedham-Smith, regional director of the Royal College of Nursing for the Midlands, criticised the loss of nursing staff.

"We cannot afford to make any nurses redundant because they are working flat out right now," she said.

"There is a job freeze and has been since September so to have redundancies on top of that is just a short term approach to address the deficit."

The trust said any redundancy notices would not be served until July 19 when a 90-day statutory consultation period ends.