Hospital services in east Kent are to be shaken up in a move which could lead to one super site and several downgraded hospitals.
But health bosses say they are yet to decide which of the three key hospital sites in the area will be upgraded to become the super medical site.
Under observation are the Kent and Canterbury, the William Harvey in Ashford and the QEQM in Margate.
Three new specific roles have been defined for the hospitals as part of a bid to save £292 million across Kent and Medway - but it's not been revealed what will happen where.
It would mean:
The East Kent Hospitals Trust is already wrestling with a £35 million deficit and trying to get out of special measures.
East Kent Hospitals University Foundation Trust chief executive Matthew Kershaw said: “It would be wrong to speculate as there is still a lot of work to do.
“We are being open and honest and can’t say which hospital it will be. They are only emerging ideas which have not yet been worked out to that level of detail.
“Everything is possible, but will have a preferred choice when we go out to consultation.”
But already there is speculation that Ashford, which already has the main trauma unit, is in prime place to become the super site.
That would mean Kent and Canterbury Hospital could be further downscaled, losing its renal and urology departments as well as vascular, neuro-rehabilitation, radiotherapy and cancer services.
Canterbury MP Julian Brazier says he is concerned about the potential “progressive slide” of all specialist services to Ashford.
He called on the trust to produce a longer term vision for a new hospital in Canterbury, which he maintains is best placed in the centre of East Kent for patients.
The controversial plan has been revealed as the Government tasks all health and hospitals trusts and local authorities to come up with a ‘sustainability and transformation plan’ aimed at more joined up working with GPs and social care - and to save money.
Mr Kershaw pledged that several options for the new roles for the hospitals in Canterbury, Thanet and Ashford, will go out to public consultation before any decision is made.
He said: “We are looking at a model of care which makes best use of all our hospitals.
"Providing services across our sites in different ways means we can provide better care and outcome for patients because we can give them the specialist care they need from a single expert team, instead of stretching every specialist service across multiple sites.”
He added: “While in future you may not be treated at your closest hospital, you will get care in an east Kent hospital that can provide the best treatment for you.”
But Ken Rogers, who was vice chairman of the now dormant Concern for Health in East Kent, known as CHEK, described the future for the K&C as “very worrying”.
He said: “From what the trust is now proposing, it seems obvious that the William Harvey at Ashford will be the preferred choice for the specialist centre and I can see the advantages of that system in offering the best care.
“It’s a pity because Canterbury is best located to be the major centre but we were told it many years ago that it would cost £100 million and the trust couldn’t afford it.
“I think there will be a lot of upset if there is a declining role for the K&C because it has a special place in many people’s hearts.
“But the old building is just a money pit to maintain and I wouldn’t be surprised that if there are so fewer services at Canterbury, it will be demolished to make way for housing.”
It is 20 years to the week that the hospital lost its A&E department, sparking a huge campaign and a 20,000 strong protest.
The trust estimates there could be a £141 million hole in the area’s NHS and social care budgets over the next five years if it doesn’t act.
There are around 300 patients in hospitals at any one time who don’t need to be there, say health chiefs.
They believe the answer is to expand services at GP surgeries where a much wider range of treatments and support would be offered.
The proposal is being worked on alongside the scheme to re-define the roles of the three hospital sites.
The trust estimates hundreds of thousands of pounds are being spent every week on hospital patients who could receive better care at home and from GPs, if the right support was in place.
Canterbury MP Julian Brazier says he has “serious reservations” about all the specialities ending up in Ashford.
He said: “I entirely accept there has to be radical change because the NHS and hospital trusts face huge challenges from an ageing population and as new treatments become available.
“I worry about the progressive slide to the William Harvey Hospital which is at the periphery of east Kent" - Julian Brazier MP
“I also fully support the idea of getting more people treated in primary care.
“But I have concerns about all the specialities being concentrated in Ashford, if that becomes the major site.
“I worry about the progressive slide to the William Harvey Hospital which is at the periphery of east Kent.
“I also have reservations about the lack of any long term vision in the trust’s plans.
“One new major hospital in Canterbury in the centre of east Kent is the best solution. I appreciate there is currently no capital for investment.
"But the NHS is not always strapped for cash and it has to be worth trying to get that funding in the future.”
Faversham and Mid Kent MP Helen Whately said: “I’m optimistic that the plan is good enough to secure Kent and Medway over £100 million in extra funding for healthcare by 2020. “However, I was disappointed that the proposal in the STP (Sustainability and Transformation Plan) for East Kent does not include the option of a new specialist hospital near Canterbury. “I want to see a bold long-term vision for East Kent hospitals – a view I have repeated to the NHS frequently since I was elected."There has to be a proper consultation on the future of hospitals, which looks at all the options, with real ambition.”