Managers in the Welsh NHS have said making £380 million of savings by April next year is the biggest challenge they have faced in two decades.

Hospital services have been altered and savings goals have been placed on staff pay in a bid to drive down costs this financial year, research by BBC Wales found. The result of October’s UK government public spending review will determine if more cuts are necessary.

The review is “profoundly important for Wales”, according to the assembly government. Fundamental changes to make savings have been forecast by some health boards, while a number have put “rigorous vacancy controls” in place already and said the coming years will see “fundamental service reconfiguration”.

A document from one health board warns “tension will increase” between what the NHS can offer and what patients will expect.

Betsi Cadwaladr University Health Board, Wales’ largest health organisation, faces a savings target of more than £70m in 2010-11 from its annual budget of over £1 billion.

“I wouldn’t pretend that its easy, but there are opportunities,” said vice-chair Dr Lyndon Miles. “We are looking at lots of areas - we are looking at the way we spend at the moment, for example employing locums and agency staff and the way we recruit.”

The seven health boards and three health trusts in Wales have all targeted reforming the workforce and reducing with wage bill, with Betsi Cadwaladr UHB aiming to making £14m savings in this area in 2010-11.

The health board has already begun moving more services into the community after announcing plans to close HM Stanley hospital in St Asaph, Denbighshire.