One of North East England's biggest hospitals could be closed under new multi-million pound plans to restructure hospitals in Newcastle.
The RVI could be modernised under the plans
A Private Finance Initiative (PFI) could be used to modernise the city's two main hospitals - the Freeman and the Royal Victoria Infirmary - gradually phasing out Newcastle General.
The £180m revamp still needs to be considered by the government, but Newcastle Hospitals NHS Trust board has already given the plan their approval.
Other PFI hospitals in the region, such as the University Hospital of North Durham, have attracted criticism for problems including too few beds.
Health Secretary Alan Milburn defended the decision to use private finance.
Quite simply, what we are doing is mortgaging our future when we go down the PFI route
He told BBC Radio Newcastle: "I think it is a step forward because anyone who is familiar with the General site will realise that these are very, very old buildings.
"You cannot deliver 21st Century healthcare in 19th Century buildings.
"These developments have been long in the pipeline... it will be an investment of tens of millions of pounds and provide the city with the sort of modern hospital services it needs.
"In the end I think what most people care about is getting the modern facility rather than how it is built."
But Liz Twist, northern region head of health for Unison, told the BBC she did not believe PFI was the best option.
She said: "Quite simply, what we are doing is mortgaging our future when we go down the PFI route.
"It costs more to borrow money using the private sector route than if a public body borrows it.
"From our perspective as service users, we want to see all the money going into directly provided healthcare services.
"What is happening here is that some of that money is going into the pockets of shareholders."