Two Midlands hospitals could close and be replaced with a new hospital development and community facilities, according to plans unveiled yesterday.
Birmingham's City Hospital and Sandwell General Hospital, in West Bromwich, may be closed as more hospital-based services are relocated to local health 'hubs'.
But nothing has been decided yet - it is just one of four options shortlisted for a £750 million scheme to revolutionise healthcare across Sandwell and west Birmingham.
The other proposals range from refurbishing existing facilities to building several new community hospitals.
Towards 2010 - a joint initiative between Heart of Birmingham Teaching Primary Care Trust (tPCT), three Sandwell PCTs and Sandwell and West Birmingham Hospitals NHS Trust - aims to improve healthcare, social services and buildings.
However, Antony Sumara, chief executive of Heart of Birmingham tPCT, is adamant this is not about just about closing hospitals.
He said: "I understand there will be a strength of public feeling about the hospital and A&E options during the consultation period.
"But people's perception of what A&E's role is may be fairly old-fashioned, and they will therefore be worried about how Option B would work.
"This consultation has the potential of being a lifechanging opportunity for the local population.
"There are so many issues around depravation and ethnic health but the health facilities in this area in particular are quite poor. We've got to look at how we're going to improve community-based facilities, to make it easier for people to access health services."
More than 90,000 people go to City's A&E department every year, but Mr Sumara believes at least half do not need to be there.
Three of the four proposals would help ease the pressure by providing new 24-hour facilities where patients could get minor injuries and ailments treated.
Mr Sumara does not believe the public will opt to keep the existing facilities and services.
He said: "I think they will say things like 'We want more local services,' 'We don't want to travel across the city for an out-patients appointment' or 'We want to be able to access services locally in an emergency.'
"Option B could result in five or six community hospitals. These won't be hyped up GP surgeries, they will have a range of services that previously people would only be able to access by going to hospital.
"Urgent care centres will allow people to get medical care 24 hours a day, but they will not replace A&E because they will still be needed to cater for major traumas like car crashes."
Option B also states emergency services would be " concentrated" on one site.
In April, Sandwell opened a new £18 million Emergency Care Centre, while the Birmingham Treatment Centre is currently being built on City Hospital's Dudley Road site.
While Mr Sumara, who is also chief executive of the Towards 2010 Agency, confirmed the new units would remain, they may be used to house different services.
He said: "Whatever happens the Birmingham Treatment Centre, Sandwell Emergency Care Centre and Rowley Hospital will remain fixed points, and will continue to provide a range of services.
"We'd be pretty daft if we didn't utilise the new units at City and Sandwell as part of this scheme."
Both Options C and D would result in both hospitals closing and a new one being built somewhere between the two existing sites.
Mr Sumara added: "It's not about building a new hospital or closing one it's about making a big difference - to improve our healthcare facilities." n Formal public consultation exercise begins in February 2006 but for more information about the proposals visit www.towards2010swb.nhs.uk