Controversial proposals to move A&E surgical services from a Birmingham hospital to the Black Country were approved by Health Secretary Alan Johnson yesterday.
Campaigners were "shocked and disappointed" to learn they had lost their fight to stop emergency surgery being transferred from City Hospital, in Winson Green, to Sandwell General, in West Bromwich.
Their main concern was that patients, including knife and gunshot victims, treated at City would face an extra 15-minute journey. The proposals were amended to include a 24-hour surgical assessment unit at City in what was seen as an attempt to offset public concerns over having to travel six miles further.
The shake-up is set to be completed by next December.
Mr Johnson, in a letter to Councillor Deirdre Alden, chair of the city's health scrutiny committee, said he was "satisfied" Sandwell and West Birmingham Hospitals NHS Trust's plans are "in the interests of the local health service and users".
"Rather than leading to a reduction in service, I consider that the proposals will enable the trust to improve services for local people," he added.
Coun Alden (Con Edgbaston) last night claimed the Department of Health had "sneaked this out when they thought nobody would be looking".
She added: "But people will notice when they have no emergency surgery services at City Hospital. If they are unlucky enough to have a serious accident in the city centre, they will be taken directly to Sandwell instead of City.
"We did all we could but we have no further recourse on this issue."
Mr Johnson's decision comes as the Independent Reconfiguration Panel, which investigated the trust's plans, published its report. It includes conditions of improving transport links between both sites for patients, families and carers, and an out-of-hours protocol for patients who need emergency surgery at City.
Dr Peter Barrett, the IRP's chairman, said: "We agreed unanimously that for the proposals to provide a safe, sustainable and accessible solution, the trust must develop a number of underpinning protocols.
"During the course of our review we have listened to people from all sides of the debate including patients, staff, local authority representatives and interest groups. We are confident that our recommendations are in the best interests of local people."