Real terms NHS funding growth would be squeezed to 0.5 - 1 per cent a year from 2011 under the best case scenario for recovering from the recession outlined by consultants PricewaterhouseCoopers.
They estimate the total budget deficit will reach the equivalent of£43bn by 2013-14 - a third more than the Treasury has so far calculated.
PwC's most drastic proposal to fill that gap would be a real terms cut in public spending of 1.4 per cent a year between 2011-12 and 2013-14.
Its alternative would be a real freeze in total public spending, which would allow very small increases in NHS and education funding, but would need to be coupled with around£25bn in tax increases.
It came as NHS medical director Sir Bruce Keogh told HSJ that clinicians needed to respond to these pressures by improving their effectiveness and efficiency, rather than reverting to a "head to head" stance with management.
"The risk is that when things are difficult it is easy to [return to the] status quo, particularly for professional groups," he said.