The West Midlands suffered the second highest number of compulsory redundancies in the NHS in England in the first half of this financial year, according to official figures.

The 903 redundancies nationwide between April and September 2006 included 167 clinical staff and 736 non-clinical workers, according to Department of Health figures released yesterday.

The worst-hit area was London, with 299 compulsory redundancies, followed by the West Midlands with 187.

The Royal College of Nursing said the lost jobs were part of an estimated 20,000 reduction in the NHS workforce as a result of the deficit crisis hitting hospitals and trusts across the country.

"Ministers should be under no illusions about the serious impact on patients’ care if these posts are lost to the NHS," said RCN general secretary Beverly Malone.

But Health minister Lord Warner said the job losses should be seen in the context of a 300,000 increase in staff numbers since 1997 - a rise of more than 29 per cent.

"The figures we have published today show the true picture of redundancies in the NHS - just over 900, not the inflated figure some have claimed," he said.

"We have always said there will be a minority of redundancies, which is regrettable, but employers will do all they can to support those staff.

"In the main, employers are taking alternative steps to minimise the level of compulsory redundancies, such as reducing staff levels through natural turnover - which is around 130,000 staff every year in the NHS anyway - redeployment and by reducing demand for agency staff."

But Dr Malone said the bulk of the 20,000 job losses identified by the RCN was made up of voluntary redundancies and posts which will be frozen or remain unfilled.

She said she was "dismayed" that ministers had failed to provide details of these job losses alongside the much smaller number of compulsory redundancies.

"A post lost - whether through redundancy or freezing and deleting posts - means there is a job not being done and a service not being given," warned Dr Malone.

"It also leaves the staff remaining treating even more patients, placing them under often intolerable and unsustainable pressure. What also saddens me greatly is that the Government seems to be claiming 903 NHS compulsory redundancies as a success. I am sure the 903 people do not share their view."

The Department of Health today released a new framework for NHS Trusts on dealing with "managing workforce challenges".

It advised that trust managers should give staff at risk of redundancy priority when filling vacancies and ensure any who lose their jobs are offered interviews with personal careers advisers. "Internal pools" should be used to offer work to newly-qualified health professionals when vacancies arise.

Employers should work with trades unions, higher education institutions and job centres; review temporary and fixed term contracts; take new approaches to flexible working hours; work with primary care employers to employ graduates; and fill as many posts as possible with British staff before recruiting abroad, said the guidelines.