The trust, which employs 1,200 staff in Richmond and Kingston, will hand over its management responsibilities for mental health to South West London and St George's Trust in September, as part of a London-wide NHS programme.

But debates over who will take over the trust's other responsibilities, particularly elderly people's services, are continuing.

At a board meeting on Monday KDCT directors warned that they could become a "battleground" as to whether they are transferred to Kingston Hospital NHS Trust or the emerging Kingston Primary Care Trust (PCT).

"I think it is fair to say there have been different views expressed among the stakeholders and there needs to be a process by which the views can be heard and appropriate decisions taken," said trust chief executive Fred Little.

Staff are being updated about changes to allay fears, although redundancies in some areas have not been ruled out and Mr Little added that staff were "committed" to ensuring patient care would not be affected.

But despite the uncertainty over the future of the elderly people's service, directors approved moves to look to the Philippines to fill its nursing vacancies, currently standing at 20 per cent.

Because Kingston Hospital already takes on Filipino nurses it was felt there would be no conflict with the new service provider after the handover.

"Kingston Hospital is the only other acute alternative to take on elderly services if the PCT doesn't and they already use Filipino nurses," said Mr Little.