By James Clarke BBC News, England

More than 3,000 NHS job losses have been announced during March

And the Royal College of Nursing says the threat of redundancy is causing morale among nurses to "plummet".

More than 3,000 job cuts have been announced by English NHS trusts since the beginning of March.

A Unison spokeswoman said anyone thinking redundancies on that scale would not affect patients was "living in cloud cuckoo land".

The Conservative Party has claimed 15,000 to 20,000 jobs could be lost across the country by trusts trying to balance the books.

The claims that these cuts can be made without any impact on patient care are just plain ridiculous Anne Mitchell, Unison

Unison health spokeswoman Anne Mitchell said the union, which represents many NHS staff, feared the job losses would continue.

She said: "We are very worried that there may be more cuts and job losses in the pipeline.

"The claims that these cuts can be made without any impact on patient care are just plain ridiculous.

"It's going to add enormous pressure to the remaining staff there.

"Our take on this would be that although the government have put money into the NHS and done that over a period of time, more and more is being diverted off into the private sector and this is money which should be given to trusts.

Job cuts announced this month Royal Cornwall Hospital - 300 Peterborough and Stamford Hospitals - 185 University Hospital of North Staffordshire - 1,000 Royal Shrewsbury Hospital and Princess Royal Hospital, Telford - 291 Derriford Hospital, Plymouth - 200 New Cross Hospital, Wolverhampton - 300 Royal Free Hospital, London - 480 Queen Mary's Hospital, Sidcup - 190 County Durham and Darlington Acute Hospitals NHS Trust - 700

"As the scale of the deficits has become clear, trusts have gone through the usual measures they would tend to do to save money, like freezing posts, not taking on agency staff, all of these kinds of measures, and they have got down to the bone.

"You get to the stage where you can't take it any further.

"I think it's damaging for patients, you can't lose swathes of staff from any organisation and it not have an impact on the people they deal with.

"The same is true of hospitals, they work as teams, the whole ethos and the way they work is by being able to act as a team, knowing they have the people in place to set up appointments and deal with patients as they come in.

"There's no fat on the NHS, it really does work extremely efficiently, and to suggest that by taking out groups of people it will not affect patients, it's living in cloud cuckoo land."

Howard Catton, head of policy for the Royal College of Nursing (RCN), agreed that patient care would be affected.

Mr Catton said: "We are looking at more than 4,000 jobs which are at risk of redundancy and more than 1,000 nursing jobs which are part of that.

We have been warning the government this was likely to happen Howard Catton, Royal College of Nursing

"We are very aware it's front line staff treating patients.

"If you are taking out hundreds of staff from a hospital it will have an impact on patient services."

Mr Catton said the RCN had been monitoring the debt of the NHS for some time and had predicted heavy job losses.

"We have been warning the government this was likely to happen," he said.

"Ten months ago, trusts started to cut down on the use of agency staff, then we saw services affected and operations delayed and unfortunately this is the latest development in how trusts are dealing with their deficits.

"Nurses feel really angry that they have helped to deliver a lot of government targets and when things are squeezed it's their jobs on the line.

"It's having an impact on morale, morale in those places where they have announced redundancies has plummeted.

"We have found that nurses on average work an extra day a week unpaid by staying after the end of their shifts, perhaps they won't continue to offer that goodwill.

"We know there are other trusts out there that have got the same level or worse debts and I'm afraid I don't think we have heard all of these announcements and there will be more job cuts to come."

The government pointed NHS staff levels had increased significantly since Labour came to power in 1997.

And the Department of Health said it was "simply not correct" to say thousands of jobs would be lost within weeks, with most trusts expecting to make cuts over a period of years.

Health secretary Patricia Hewitt said: "Over the last nine years the NHS has taken on over 200,000 more staff.

"Even where trusts are now making some reductions - starting with agency staff, managers and administrators - patients should be reassured by the determination of clinicians and management to maintain the best care for patients.

"Let's not forget that most of our hospitals are not only improving patient care, and not only hitting targets, but they're doing it within their substantially increased budgets."