A £300m project to extend and modernise the biggest hospital in the South West is in crisis.
Plans are already in place to refurbish Derriford Hospital
Two of the three bidders for the Vanguard Project contract at Plymouth's Derriford Hospital have pulled out, leaving just one in the running.
The plan to change the face of hospital care in the region will almost certainly now be delayed.
It includes a centre with 17 operating theatres and 400 beds for routine surgery and care planned in advance.
The project is to be built under the government's private finance initiative (PFI) built and owned privately then effectively leased back to the NHS.
Now, however, two of the three bidders for the contract have dropped out - one to concentrate its business elsewhere, the other for the lack of a business partner.
South East Cornwall MP Colin Breed said any delay could cause problems for health provision in the region.
He said: "We know there is growing demand for the hospital, and with that growing demand we have to match capacity. Any delay could be extremely damaging."
Health unions argue hospitals should be publicly funded and say the current situation proves the shortcomings of the policy Gary Smith of the GMB said: "Private finance is supposed to be about private companies competing to build and run NHS services.
"With only one company in the running, then there is no competition." Hospital managers have admitted to staff they are uncertain what to do next.
Plymouth Hospitals Trust Medical Director Terence Lewis said: "It's unfortunate and we hoped that it wouldn't happen. It's a project that everybody realises is absolutely essential to do.
"We'll have to take a deep breath and try and work out what direction to go and there are a number of alternatives, I gather.
"There has been no single-bidder process in England, but there has been one in Scotland. We'll look at the model and see a different way around it.
"But it's got to happen, everybody accepts it's got to happen, and the sooner it happens the better."