Job cuts and “unmanageable” workloads on frontline staff are threatening the NHS despite protection in the latest spending review, leading medical unions have warned.

George Osborne said he was continuing the Government’s commitment to protect the health service by increasing spending above inflation from £104 billion this year to £114 billion in four years time.

But the 1.4 per cent growth in real terms is lower than increased amounts pumped into the NHS during the past decade and Midland hospitals are being forced by the Department of Health to make savings of £87.5million this year alone to prepare them for the coming years.

The Chancellor also revealed health trusts would be forced to save up to £20 billion a year through “efficiency” programmes.

Although these savings will be reinvested in the NHS, there are fears that these efficiencies will mean health workers losing their jobs, plus there is also the abolition of all Primary Care Trusts (PCTs) and Strategic Health Authorities by 2013 to slim-line levels of management.

Paul Vaughan, Royal College of Nursing (RCN) director for the West Midlands, said: “We’re concerned that despite the Government’s promise to ring fence funding for the NHS, trusts on the ground have been directed to make millions of pounds of savings to compensate for lower increases in their budgets over the next few years.

“We already have evidence of 10,000 posts in the NHS across the country that are earmarked for cuts through redundancy and, less visibly, through recruitment freezes or staff not being replaced when they leave or retire.

“This year alone, the major hospitals in Birmingham face having to find more than £66 million in savings, and this squeeze on funding will continue into next year and beyond.

“Nurses and health care assistants are telling us that they are already under great pressure to do more with less.

“We recognise that savings do need to be found, but these must not be at the expense of patient care, nor must they make the nursing workload completely unmanageable.

“One of the lessons of the failings at Stafford Hospital was the link between unacceptably low staffing levels and patient safety, so it’s paramount that frontline jobs and services are protected.”

Dr Hamish Meldrum, chairman of the British Medical Association, also raised issue of cuts to services.

“Although the NHS budget has been relatively protected, the health service has to find cost savings of £20 billion by 2014 and this is already resulting in cuts to services, staff and rationing of treatments,” said Dr Meldrum.

“The NHS continues to face the demands of an ageing population and the rising costs of medicines and new technology.

“Cuts in spending in other areas, such as welfare benefits, will also have a knock-on effect on demands on the NHS.

“Vulnerable groups often have complex health needs and it is essential that help remains available to them.

“If the Government is truly committed to reducing waste and inefficiency, their proposals for NHS reform should focus less on competition and more on a cooperative approach on delivering healthcare.”

Mr Osborne also announced added investment with a new £200 million a year cancer drug fund to help victims get advanced treatments, more access to psychological services, the protection of health research and public health funding plus a £2billion boost for social care.