A leaked letter has laid bare the devastating impact that an imminent £31m in budget cuts will have on frontline health services in Northern Ireland.
In the letter, a senior official has admitted that cuts will mean patient care being compromised, beds closing, targets being missed and emergency departments suffering.
Patients can also expect operations to be delayed, waiting lists to grow, diagnoses to be slower, dirtier wards and residential care homes to close.
The letter from the director of finance and contracting at the Western Trust contains its proposals for making savings of £4.6m in 2013/14.
However, all trusts have been asked to make similar savings in order to 'break even'.
The Western Trust plan also proposes that a quarter of all medical cover – for staff on sick or maternity leave – should no longer be provided.
That £4.6m figure represents a drop in the ocean of the Western Trust's annual budget of more than half a billion pounds.
However, the effects could be far-reaching, according to Maeve McLaughlin MLA, Stormont's new health committee chairwoman.
"These are shocking and alarming proposals which are coming from the Western Trust, which has to save £4.6m and I will be asking what 'break-even plans' have been put forward by other health trusts in relation to the £26.4m they have to save," she said.
The shocking revelations came to light after a letter dated August 23, 2013 between Western Trust finance chief Lesley Mitchell and Owen Harkin – Director of Finance at the Health and Social Care Board (HSCB) – was obtained by the Belfast Telegraph.
Mr Harkin had asked for a breakdown of how the Western Trust plans to 'break even' in 2013/14.
However, the HSCB confirmed that every other trust faces the same demand – to the tune of £26.4m – a total of £31m.
If trust proposals are accepted, the cuts could be introduced as early as next month.
In her letter, Ms Mitchell made it clear that cuts will come at a high cost to staff and patients.
She wrote: "As described in my letter of August 8, 2013, any further contingency measures required from the trust would have a significant impact on services and as such would require the commissioner/departmental support before implementation."
A spokeswoman for the HSCB said: "The board is engaging with all trusts to understand the basis of the current and projected positions and has requested a detailed narrative which analyses and explains the reasons to the current forecast position.
"The board has also sought a view on contingency plan measures to address the changing financial position.
"This work will not be completed until October. In the meantime no decisions on changing the planned levels of activity for this year have been taken."
A spokesman for the Western Trust said the cuts plan was a result of new pressures on the trust and an "ambitious savings plan" set by the Executive.
He added: "All health and social care trusts in Northern Ireland are facing similar financial challenges and are in ongoing discussions with the service commissioner and Health and Social Care Board regarding the potential for savings and reinvestment."
A spokesman for the department of health said: "These appear to be early draft proposals.
"No such proposals have been seen by the minister and it would therefore not be appropriate to comment further.
"Proposals are under consideration between the trust and the Health and Social Care Board and will be submitted to the department at the end of this month."