By Branwen Jeffries
BBC News health correspondent
The decision by Alan Johnson to back two major hospital reorganisations is likely to be seen as sign of government intent to press ahead with changes that are often intensely controversial in local communities.
Midwives could run units
The changes to hospital services in Greater Manchester are the first such plans that Mr Johnson has been asked to approve since he became Health Secretary.
The announcement had been delayed after the Health Secretary said he wanted to take more time to consider his decision.
What happens in Manchester is likely to be watched closely by campaigners in other parts of the country where hospital services face reorganisation.
The public consultation in Manchester on maternity services prompted more than 50,000 formal responses, an indication of the level of interest and concern.
Two government ministers whose constituencies are in Greater Manchester had objected to the proposals to remove consultant led maternity units from their local hospitals.
Hazel Blears joined protesters last year outside Hope Hospital in Salford, and Ivan Lewis expressed concern about the future of services at Fairfield hospital in Bury.
Under the plans backed by Alan Johnson, neither hospital will retain a doctor led maternity unit.
That would mean women considered at higher risk, such as older mothers, would have to travel further afield to give birth at a unit supervised by a senior doctor.
The report recommends that the option of a midwife led unit at both sites should be strongly considered.
A government spokesman said the plans in Manchester would involve greater investment in health services and were necessary to ensure access to safe, high quality services.
The Department of health said £38 million pounds of additional funding would be put into changes to emergency provision and £60 million pounds of capital investment in maternity services.
The government has promised to give women a choice of where they give birth by 2009.
More or less choice?
But the decision to go ahead with changes comes in a week when the Conservative leader David Cameron said he would fight to defend the principle of the district general hospital offering a full range of services.
Responding to the latest news, Shadow Health Secretary Andrew Lansley said he was concerned that the proposals would restrict choice for women.
He added "I am concerned about the basis on which this consultation went ahead. It was clearly driven by pressures from the European Working Time Directive [to limit doctors' working hours] and it failed to adequately reflect how access to services impacts the overall quality of care.
"Attendances at A&E continue to rise and the number of live births has increased."
The government says there is a strong clinical case for change, and they have received some support from clinicians.
The government has promised mothers choice by 2009
But local hospitals prompt fiercely protective sentiments from their local communities, and it has remained hard to convince patients that significant changes are in their best interests.
Thousands of patients have signed petitions or joined marches to express their concern about possible changes to their local hospital.
The district general hospital has been a cornerstone of the NHS since the 1960s but some experts now argue that changes in technology and treatment mean the NHS now needs to rethink how and where hospital care is provided.
It has become government policy to shift more care into clinics in the community, and centralise some others in larger more specialised units.
The chief executive of the NHS David Nicholson has said that maternity, paediatric and emergency care need to be reorganised in some parts of the country.
In an interview last year he said there could be as many as 60 reconfigurations of hospital services in England.
Public consultations have recently been launched on changes to hospital services in London, and change is also expected in Kent, Surrey and Sussex.