The shape of hospital care in Brighton is likely to undergo a fundamental transformation.

Instead of four separate hospital sites treating patients from their immediate neighbourhoods, proposals will be drawn up to combine the town's major NHS hospital work on one site. The project could cost as much as £40 million over several years.

The redeveloped care centre, set to take shape in the Royal Sussex County Hospital's Eastern Road grounds, would treat patients from a catchment area nearly twice its existing size, taking in patients from Mid Sussex as well as Brighton, Hove and Lewes. It is an ambitious project combining services offered by the Royal Sussex, Brighton General, Sussex Eye and Royal Alexandra Children's hospitals.

But health managers are bracing themselves for future unease from patients nervous about the loss of landmarks like Brighton General and the Alex and how hospital services they have known for decades might change or cope with increased workloads.

Stuart Welling, chief executive of Brighton Health Care NHS Trust, which runs the Royal Sussex, has assured patients and other health groups they will be consulted about possible changes. He said: "It's a daunting challenge. Things have got to change. But we will see evolution rather then revolution in terms of changes that take place.

"Hospital service providers in central Sussex will work with social services, Primary Care Groups, ambulance services and other NHS trusts taking account of users', carers' and relatives' views."

The call to replan Brighton's hospital services on one location forms the basis of the Central Sussex Review, a major body of work set up last April to reorganise health services in East and Mid Sussex. Although health bosses had already planned to move services out of the Alex and Brighton General during coming years, recommendations from the Central Sussex Review will almost certainly see those moves accelerated.

The review, which will be considered by health chiefs in Brighton tomorrow, recommends a closer working relationship between the Princess Royal Hospital in Haywards Heath, and the Royal Sussex so they treat a combined population of up to 500,000 rather than independent groupings of patients.

Health planners will use this year to debate which services will be moved and gauge how changes might affect patients.

Proposals would be put before East and West Sussex health authorities and the public for consultation before they went ahead, but will see some medical work moving from Haywards Heath to Brighton as well as the specialists from Brighton treating Mid Sussex patients.

The trade-off between proximity of services and quality of care has been a thorny one. It's a tough job to convince the sick or elderly that travelling an extra 15 miles will be good for their health. Indeed, a similar review which recommended moving accident and emergency and maternity from Crawley Hospital to East Surrey Hospital drew scathing criticism from patients who feared lives would be put at risk by extra travel and added pressure at East

But trusts involved with the Central Sussex Review will argue their massive body of work centres around improving quality of medical care, and patients will be travelling for specialist treatment on wards which have been expertly honed to offer first-rate care.

Stefan Cantore, of Mid Sussex NHS Trust, which runs the PRH, said although patients from Mid Sussex would have to travel to Brighton for certain treatments, others would find new specialties coming to them. He explained: "This is not a one-way street. It's also about more work coming out to people closer to their homes."

Mr Welling added: "Integration does not solve everything. But integration maximises the options for handling new developments in health care, national policy and local circumstances."

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