Reforms recommended by the Francis inquiry and Keogh review could cost healthcare providers up to £1.2bn, several times the sum earmarked by government agencies for the changes.

This is the chief finding of a financial analysis by the Foundation Trust Network, which examined the accounts of all 245 providers.

A poll of the trust members also revealed low levels of confidence in NHS England and Monitor’s claim that £150m in national tariff increases will cover the cost of implementing the reforms.

Just 12 per cent of the 50 respondents said they were confident that the service development uplift or local financial agreements with commissioners would cover the costs of service change recommended in the Francis and Keogh reviews. Seven out of 10 said they were not confident.

The FTN analysis suggests that the acute sector would face £1bn in costs – £400m in 2013-14 and £600m in 2014-15.

The non-acute sector faced a two-year bill of £160m that includes almost £50m in 2013-14 and £112m in 2014-15.

The sums were worked out by extrapolating costs submitted by some acute and non-acute trusts across the whole sector.

FTN chief executive Chris Hopson criticised NHS England and Monitor’s “differential tariff”, which will increase payments to acute trusts for implementation costs in 2014-15 but not for the non-acute sector.

“The differential tariff is unacceptable because it’s seen to be giving a very clear message that it’s only the acute sector where these costs are going to be incurred, and that’s patently untrue.”

The analysis also suggests that more than 95 per cent of costs for the acute sector will go on extra staff, while non-acutes will spend 88 per cent on increasing staff numbers.

Survey respondents told the network they were receiving mixed messages, Mr Hopson said.

“Our members have said they feel they’ve been given completely conflicting signals.

“On the one hand we’ve got [Care Quality Commission] inspections, the Keogh review report, the Francis report saying we need more staff.

“On the other hand we’ve got the better care fund effectively taking £2bn out of the acute sector. Given that 70 per cent of an acute trust’s costs are in staff you’re not going to take £2bn out without moving staff. So our members are saying, ‘Which do you want us to do?’”

Trusts were having to make tough decisions between finance or quality, he added.

“The phrase that we hear a lot at the moment is: ‘If I’m going to be hung for something, I’ll be hung for the finances rather than the quality’.”

A spokeswoman for NHS England said: “The decision on the £150m component of the service development uplift was made based on the evidence available at the time in December 2013.”

She added: “We are working with Monitor to review the methodology and will welcome evidence and contributions from the sector on costs such as this survey from the FTN.”

Post-Francis and Keogh changes could cost trusts £1.2bn, says FTN