More wards could face closure at the Queen Elizabeth Hospital, it emerged last night.

Health chiefs said the changes were about making the 20-ward QEH more efficient and no staff at the hospital would be made redundant.

But the disclosure comes less than a month after the trust which runs the hosptial was one of 11 named as being in 'severe financial difficulties' by health watchdog Monitor.

The QEH said an 'efficiency savings programme' was in place, after it finished the 2011/12 trading year with a surplus of �1m, instead of the �2m budgeted. Two wards - Marham and West Newton - have so far been been closed this year.

Last night QEH chief executive Patricia Wright said: 'The closure of two wards this year has allowed us to concentrate specialist resources where they are needed as part of our programme to improve the flow of patients through the hospital. As we make further changes in our care pathway we will close facilities that we no longer require.

'We are continuing to look at ways of improving efficiency, as all health and social care organisations are required to do, in line with national policy.

'For example, many more patients are now treated as day cases for minor conditions, which means they can have their operation and return home the same day. We also have 'outreach' facilities in Fakenham and Littleport for minor surgery that once might have warranted a hospital stay.

'We are working very closely with primary care and social services as this approach is entirely in line with the need for more care to be provided closer to home.

'The Trust is closely monitoring the quality and safety impact of all of the changes it is making and there is no evidence to suggest that patients are being discharged too soon.

'We are also using the opportunity to improve the skill mix of nurses on our remaining wards which means there have been no redundancies as part of any changes we have made.'

Last night Patrick Thompson, chair of patient lobby group Norfolk LINk, said it would monitor any change at the hospital.

'We will need to monitor this, see what the outcomes are and see if there's a deterioration in the service.'

The QEH was given the go-ahead to become a foundation trust in January 2011. Managers said the move meant the hospital would have more freedom to decide how to spend its money, while patients would have more say over the way it was run.

But last month David Bennett, chief executive of health regulator Monitor, said the QEH and 10 other hospitals were in such serious financial difficulties that they would not have been allowed to become foundation trusts if they were to be assessed now. Both claims were disputed by the hospital.

On September 25, its finance director David Stonehouse told the hospital's annual meeting:

'It was a good year and we worked very hard,' he told the AGM. 'But Monitor were right. Our financial planning was not where it needed to be and as a consequence we were not able to deliver what we wanted to deliver in terms of investing in the hospital.'