David Cameron, the Conservative leader, claims the financial crisis in the health service is costing 20,000 jobs – a figure which NHS Employers, representing health service managers, has said “may turn out to not be too far off the total reduction in workforce numbers this year”.

Health Direct’s current running total stands at 19,088 jobs lost.

Mr Nicholson admitted that the 20,000 figure was the only estimate that had been produced so far, but argued that the true number of jobs lost would be “significantly less”.

When challenged to give his own estimate, he admitted that he did not know what the final figure would be.

An increasingly impatient Tony Blair intervened to say that, according to documents he had seen, most staffing reductions would involve posts remaining unfilled or people being moved to new positions. He believed that compulsory redundancies would number only “a few hundred”.

A survey by NHS Employers suggested that the total head count reduction might reach 20,000, though the organisation stressed last week that this figure related to cuts in numbers of posts and not to individuals losing their jobs.

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Health Direct also reports that the claim by bliar that compulsory redundancies would number only “a few hundred” was described by Dave Prentice the head of the Unison union as showing how out of touch with the real world the prime minister has become.