A long-awaited £550 million rebuild of Birmingham's Queen Elizabeth Hospital is still awaiting Treasury approval - almost a year after the deal was due to be signed.
Hospital managers fear there is still no guarantee the rebuild will go ahead.
Last night Mark Britnell, boss of the NHS Trust behind the super-hospital, said: "We need a decision soon."
He was confident the Treasury would approve the scheme, which has the support of the city council and every local health trust, and added: "It is Birmingham's turn and we can't afford to miss out."
Mr Britnell, chief executive of University Hospital Birmingham NHS Trust, which runs the Queen Elizabeth and Selly Oak hospitals, said: "We are perturbed by the delay. It is time for people to put their money where their mouth is."
However, Ministers cast doubt over the hospital rebuilding programme when they launched an investigation into a similar scheme in London.
Health Secretary Patricia Hewitt ordered an "urgent review" into a £1.2 billion Private Finance Initiative project to rebuild St Bartholomew's and the Royal London hospitals.
The Queen Elizabeth project, which includes a specialist psychiatric hospital as well as a 1,249-bed acute super-hospital, is also funded using PFI.
But the Treasury has still not approved the deal and the Department of Health yesterday revealed PFI schemes nationwide were being reviewed. A DoH spokesman said no decision had been taken about the QE.