Three hospital trusts have backed merger proposals that might create one of many largest NHS trusts.
The boards of Basildon, Southend and Broomfield hospitals in Essex have permitted the formal begin of the method.
A merger would “modernise companies” and make care “extra dependable and safer for sufferers”, a consultants’ report mentioned.
Opponents are involved the transfer may scale back the variety of companies and have an effect on employees’s pay and circumstances.
The three trusts have a mixed monetary deficit of greater than £49m, in response to board papers.
A brand new single organisation protecting all three areas might be in place by April 2019.
A report mentioned analysis recognized below-average efficiency in areas together with most cancers ready instances, affected person experiences and care and help for sufferers with long-term circumstances.
“Change has to occur to keep up the protection and high quality of care sooner or later, and in a means that may enhance outcomes for sufferers and help our employees,” it continued.
If permitted, the brand new belief would serve greater than 1.1 million individuals throughout Essex, using greater than 14,000 employees.
The hospitals have labored collaboratively since 2016, and are at the moment run by a joint govt group.
Chief govt Clare Panniker mentioned plenty of choices had been examined “in a rigorous appraisal course of”.
She added: “The really helpful possibility is to work as one organisation.”
Mike Fieldhouse, secretary of Save Southend NHS, mentioned the group was “very a lot opposed” to the merger.
“This may inevitably result in a discount within the variety of companies accessible domestically to sufferers, plus the potential implications for employees contracts, circumstances and pay are large, too,” he mentioned.
Following the assembly Nick Alston, chairman of the Mid Essex Hospital Providers NHS Belief – which runs Broomfield Hospital – mentioned he hoped the modifications would create a employees “extra motivated and extra enthusiastic”.
“Nurses love working right here however are in search of extra alternatives for coaching. It is going to be simpler to ship this [with the merger],” he mentioned.