The largest hospital trust in Sussex has warned tough times are ahead after revealing it has

to save more than £34 million this year.

The news has sparked fears patient services and jobs may be affected at Brighton and Sussex University Hospitals NHS Trust.

The trust has already earmarked some £15 million savings and is hoping to borrow a further £10 million.

But this will still leave a potential shortfall of more than £8 million.

Senior members of the trust are negotiating with the Surrey and Sussex Strategic Health authority and Brighton and Hove City Primary Care Trust (PCT) to try to head off the crisis.

Part of the problem has been caused by the trust getting less money from the PCT, which wants to spend more money on establishing services in the community so people do not have to go to hospital in the first place.

This could include larger GP surgeries with space to do blood tests or more community nurses and matrons who can see people in their homes or at GP practices.

The hospitals trust board does not believe the changes will be in place quickly enough and people will still have to use its services in the meantime. This means it is effectively continuing to provide the same services as before but with less money.

Chief executive Peter Coles said the reduction of money from the PCT was not the only issue and the trust needed to look at its own performance and become more efficient. He said protecting patient services was the main focus at all times.

One area being looked at was the number of outpatient and follow-up appointments provided by the trust, which is above the national average in some departments. Patients could be sent to their GP or a community nurse instead.

Mr Coles said he could not rule out redundancies for clinical and support staff but this would be a last resort and something he hoped to avoid. He said the trust would focus initially on cutting back on agency workers and not-filling posts which were already vacant.

A spokesman for Unison said: "This sort of thing can leave members feeling uncertain and worried. We have had the urgent call from management to look to make savings on a regular basis but this is the worst I've heard of.

"There are several concerns that will be raised by staff. If vacant posts are not going to be filled then that will make things worse and patients may suffer in the long term.

"We will be watching developments very closely."

Rosemary Shepherd, chairman of the independent Patient and Public Involvement Forum for the trust, said: "This is very worrying news and is causing an enormous amount of concern."