The minister in charge of the UK's hospitals warned just two months ago that healthcare was a "natural place to start" making cuts.
In ominous remarks as the government tries to plug a huge £50 billion black hole in the nation's finances, Steve Barclay said some departments could be ordered to make savings of up to 80%.
Addressing a right-wing thinktank at the start of September, Mr Barclay issued a veiled threat to managers in the NHS and beyond, hinting that they could be culled on his watch.
At the time he was Health Secretary in Boris Johnson's zombie government, but was sacked days later when Liz Truss became PM.
However he has since returned to the role under Rishi Sunak - and is expected to plough ahead with his "streamlining" plans.
His remarks in the summer suggest huge job losses are likely on his watch after Chancellor Jeremy Hunt unleashes a fresh wave of Tory austerity in his Autumn Statement on Thursday.
Unions have called for investment in health services, with the head at Unison accusing the government of ""deliberately running down the NHS".
Mr Hunt himself has admitted the NHS is on the brink of collapse - but said it needs to do its "part" in solving the country's economic problems.
During his September speech, Mr Barclay claimed to have identified more than 53,000 staff at healthcare organisations whose primary role isn't providing frontline work - such as NHS Digital, Integrated Care Systems and Commissioning Support Units.
Hinting at a cull, he told an audience at Policy Exchange in central London: "The Department for Health and Social Care is expected to account for £4 in every £10 of day-to-day government expenditure in the near future.
"It's a natural place to start to identify what can be reprioritised to meet frontline pressures."
He said the DHSC and its arms length bodies cost £2.8 billion a year to run.
Mr Barclay added the department itself employs 4,335 staff with a pay bill of £260 million and estates and other costs of £125 million.
He added that NHS England and 13 arms length organisations employ 37,200 full time equivalent staff with a payroll of £1.9 billion and other costs of around £470 million.
The Health Secretary said: "This isn't just an issue of cutting costs, it's also about effectiveness, too much management can be a distraction to the frontline."
He said department heads within the health service had been tasked with producing charts showing exactly how many staff they had, what their job titles were and how much their team cost.
"It will stimulate, I hope, a conversation within the NHS about how priorities and resources are being aligned," he said.
He said he had imposed a recruitment freeze at DHSC, which has a £260 million payroll, and demanded 20% of savings across the department - with more to follow in coming years.
"Staff at the centre need to streamline the administrative burden of those on the front line and not risk adding to it," he said.
"If we are to reprioritise back office costs to the front line, there needs to be more transparency."
Meanwhile the Health Secretary said that the number of targets the NHS is expected to deliver should be scaled back - but failed to provide any specific examples which ones he intended to scrap.
"If everything's a priority, nothing's a priority," he stated.
Christina McAnea, general secretary of Unison - which is balloting its 300,000 NHS worker members on strike action - said the government needs to guarantee investment in the NHS in the Autumn Statement.
The Royal College of Nursing has already voted in favour of industrial action.
Ms McAnea told Sky News' Sophy Ridge On Sunday: "Difficult things will happen if they do not make the right choices and one of those is the NHS is almost ready to collapse.
"Excuse me for sounding like a conspiracy theorist but I have heard so many people say it now, is this partly a deliberate attempt by the Government to run down the NHS in order to bring in some kind of organisation to run it?
"I hope that's not what they are doing, what they aren't doing is making the right choices of investing in our public services."
Meanwhile the Chancellor, a former Health Secretary, said: "There are massive pressures in the NHS, obviously it's something I know very well from previous jobs I've done and I think that doctors and nurses on the front line are frankly under unbearable pressure, so I do recognise the picture you say.
"It's also true that there is a lot of money going to the NHS and they will be the first to say where in a context where funding for the NHS is going up, we need to do everything we can to find efficiencies, but if you're saying to me that the NHS is in a very, very tricky situation, I agree and I care passionately about the NHS.
"I have spent more time thinking about the NHS than any other public service in my time in Parliament and we need the NHS to help us get out of the economic difficulties we're in, because we've got a big increase in the number of people who aren't working, aren't taking part in work even though they perhaps could, and sometimes that's as a result of long-term sickness, so the NHS is part of the solution as well as facing some very big problems."
