Pressure on UK health trusts to break even by the end of the financial year, in the face of a projected NHS deficit of £1.2bn (€1.8bn; $2.3bn), is forcing managers to take tough decisions.

A report of six month performance statistics, released last month for 2006-7, shows that 175 organisations are predicting deficits, with half of the gross deficit concentrated in 6% of organisations.

Because hospital trusts can no longer carry their debt over from one year to the next, they have been considering laying off staff and closing departments throughout the country. And GPs in many areas have been told that they must substantially cut the number of referrals to hospital.

This has prompted the Department of Health to start monitoring redundancies. It recently reported 903 compulsory redundancies in the first half of this year. Of these, 167 (18%) were clinical staff. “There will be further redundancies over the rest of the year,” Richard Douglas, finance director for the Department of Health, said in the report.

Trade union officials claim that the number of job cuts is far …