The scale of cuts and job losses being demanded by acute trusts is revealed in an eHealth Insider survey, published today.

Just over a third of respondents said their trusts were looking to make savings of more than 20% of their total budget, with another four out of ten saying trusts were looking for cuts of more than 10%.

The survey shows that the cuts are feeding through into job losses, a preoccupation with balancing the books, and reduced investment in IT.

Half of respondents said their hospital IT department or health informatics service was focused on “reducing costs, even if that means a poorer service” or on “keeping our current systems up and running”.

One director or senior manager of IT said: “We are not frontline and have taken a disproportionate hit.”

EHI ran the survey through April, and looked for responses from senior and junior IT and information managers. One hundred and two people responded, with a quarter working at board or head of department level.

The survey coincided with the end of the last financial year in which the NHS saw significant increases in funding.

Two years ago, NHS chief executive Sir David Nicholson predicted that over the next four years, the NHS could have to find efficiency savings of between £15 billion and £20 billion, to bridge the gap between reduced increases in funding and rising demand and costs.

The prediction has since become a “challenge” to find the savings, using the Quality, Innovation, Productivity and Prevention agenda. However, the EHI survey suggests that many trusts are resorting to straight-forward job losses and service cuts.

One in ten respondents said their trust would be looking to shed more than 20% of its current staff, while half said their trust would be looking for job losses of up to 20%. Nobody said their trust was looking to recruit.

However, it is clear that there is still considerable uncertainty, with four out of ten respondents picking the “we don’t know what is happening yet” option.

The survey also suggests that IT departments are not being shielded from the grim climate. A quarter of respondents said the IT/informatics budget at their trust would be cut by more than 20% in the coming year, while a further one in five said it would be cut by more than 10%.

Job losses seem slightly less severe, with ‘only’ one in ten of respondents saying their IT department or service was looking for job losses of more than 20%, a third saying it was looking for cuts of up to 20%, and a fifth saying it was not expecting to lose people.

However, a third picked the “we don’t know what is happening yet” option. “We are in the dark” said one less senior respondent, while another said “no pledges have been made to any staff”, and a third said “we keep being run over by headless chickens, so it’s hard to tell.”

The survey found that the grim financial climate is encouraging trusts to focus on their finances. A fifth of respondents said their trust’s main priority was to “achieve foundation status” – as all trusts must now do by 2014, even if they have to merge with another organisation to do it.

Four out of ten said their trust’s priority was to “achieve/maintain financial balance by cutting costs” while only one in five said it was seeking financial balance through quality and innovation, in line with the QIPP agenda. Just one in ten said their trust was still focused on improving quality for patients.

In line with this, the key focus of IT departments now seems to be on “keeping the lights on” rather than on major investment, although one in ten said they were interested in infrastructure improvements, business support systems or departmental systems.

And perhaps surprisingly, 15 respondents said they would be looking to “deliver a major PAS/EPR upgrade”: with comments suggesting that trusts in this position were looking to take on additional services or run major efficiency programmes that will require significant IT backing.

Predictably, morale has dropped, and the survey found great scepticism about whether the latest round of NHS reorganisation and reform, which has been dropped onto the savings agenda, will be worth it.

Four out of ten respondents said more providers and tighter budgets would lead to lower quality services, while a third said they would “mean the end of the NHS as we know it."

The full results of the survey are available here. There is more coverage in the Insight section.