A health trust's bid to slash hundreds of posts has seen just 20 take up voluntary redundancy.
Four thousand staff at the Maidstone and Tunbridge Wells NHS trust were asked if they wanted to apply back in October last year.
But despite needing to cut up to 200 posts, just a handful have applied, it's been revealed.
Health bosses at the trust, which runs Maidstone Hospital and the Pembury in Tunbridge Wells, needs to save £60m over the next three years.
It will now look at other ways of making cutbacks.
A trust spokesman said: "The Trust's efficiency drive is widely spread out and was never solely aimed at staff taking voluntary serverance with remuneration.
"you cannot keep on salami slicing the service like this, it has an impact on morale and it will have an impact on patient care" – unison officer simon bolton"We are reducing the amount if costs to run our Trust - about £1m a day - by getting better value for money in many ways."
This included reducing buying costs and the costs of treating patients.
It recently opened a new urgent medical unit, which has slashed the time patients are left waiting overnight in hospital for test results or to be discharged.
But Simon Bolton, regional officer with union Unison, was concerned more staff would lose their jobs.
He said “They are now going to have to start consultation on forced redundancies to ensure they get the cost savings they are looking for. That’s going to have an impact on patient care.”
He said the further cuts were "just madness".
He added: “You cannot keep on salami slicing the service like this, it has an impact on morale and it will have an impact on patient care.
“Every single job in the NHS is a frontline job they all contribute to the frontline care. If you take 180 jobs out and you will have an impact.”
He claimed any cuts to staff at hospitals in Kent would stretch the service to breaking point.
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