“There is talk of decreasing the number of managers within the system and some of that is undoubtedly sensible, as there is too much in the way of superfluous management.

“The costs of some services can be met by reductions in certain aspects in PCTs and hospitals and this is being looked at.

“Things are going to get tougher.”

Experts said extra pressures such as inflation, an aging population and an increasing birthrate would make the job of healthcare provision up to 2017 even harder.

Others are concerned the expensive infrastructure built up over the last 10 years, including PFI projects, would be difficult to support.

But a statement issued jointly by North Mersey Trusts said people did not need to panic about the situation which followed years of growth.

It said: “At the moment we have no definite picture of what will happen when the current three year comprehensive spending review ends in March 2011.

“We do know that there will be little or no increase to our current budget.

“NHS organisations in the North West are starting to look at how they will be able to continue to improve quality and meet the growing need for health care caused, for example, by an ageing population.

“One of the solutions is to look at how they can improve productivity.

“We would like to reassure patients, the public and NHS staff that no targets have been set to “cut” services or jobs.

“Trusts are being asked to explore all options opportunities to reduce duplication of effort whilst improving patient experience; new technologies and new approaches to providing care; reducing the cost of ill-health by preventing people becoming ill in the first place.

“We want to look at this from every possible angle and so will also be talking to the public about their role; for example, can we reduce the amount of prescription medicines that are wasted every year; can we talk to patients and GPs about using less expensive alternatives to certain medicines; can we reduce inappropriate use of A&E and 999 services; can we get people to take more responsibility for their own health and lead healthier lives so they do not need to use NHS services as much.”