A financial services firm is being paid £300,000 to draw up major NHS savings in Merseyside and Cheshire, a leaked letter has revealed.
NHS trusts in the region face a funding gap of nearly £1bn by 2021, and is considering merging some hospitals.
Labour says the amount being paid to Pricewaterhouse Coopers (PwC) to cut front line services is "outrageous".
The NHS says the company has provided "expertise" as it looks "to improve the health and well-being of patients".
Louise Shepherd, who is leading the project, said: "So far we have spent £100,000 with PWC and we plan to spend a further £200,000.
"The intention is to use this year to develop the skills of our own workforce to continue this work as we move beyond design and into implementation into the future.
"In total, 30 organisations across Cheshire and Merseyside will be working in partnership to improve the health and well-being of patients and to further improve the quality of services through better models of care."
'Racking up costs'
All local health and care providers in England have come together into geographic areas called footprints for which they must create a five-year Sustainable Transformation Plan.
A letter from PwC to Alder Hey Children's NHS Foundation Trust, which is leading work on the plan, shows the firm will charge £250,000 plus up to 10% extra for expenses to "understand the impact" of potential savings proposals.
Shadow health minister and Ellesmere Port & Neston MP Justin Madders said; "This plan has been developed in secret without any mandate and to be racking up such huge costs before we know whether there's going to be any public acceptance of them is a huge worry.
"At a time when front line services are being stretched more than ever, it's outrageous that such huge sums are being spent on consultants to draw up plans to cut services further."