Government approval for plans to downgrade A&E services at a Kent hospital is a "bitter disappointment", according to the county council leader.
The reorganisation would affect services at Maidstone Hospital
Health Secretary Alan Johnson has agreed the removal of emergency general surgery and emergency orthopaedic surgery from Maidstone Hospital.
Patients are to be treated at the Kent and Sussex Hospital in Tunbridge Wells.
West Kent Primary Care Trust (PCT) said it welcomed approval as the changes were in the best interests of patients.
Kent County Council (KCC's) NHS Overview and Scrutiny Committee rejected the proposals in May and referred them to the government.
A spokeswoman said it would mean seriously injured patients were taken by ambulance to Tunbridge Wells.
It would affect some 49 patients a week, with Maidstone effectively becoming a "walk-in" centre only.
KCC has expressed concern that an average daytime journey from Maidstone to Tunbridge Wells by road was 60 minutes for people visiting.
Mr Johnson has now agreed the changes in principle and they will go before the PCT Board for final approval on 31 March.
"The Secretary of State has clearly not listened to the residents of Maidstone or Tunbridge Wells," said KCC leader Paul Carter.
"I am bitterly disappointed by this decision, which I believe is ill thought through and will reduce the quality of patient care substantially.
"It is not in the interests of patients and my very real fear is that lives could be endangered."
The PCT said that under the proposals, both Maidstone and the Kent and Sussex hospitals would continue to have consultant-led A&E departments.
Maidstone would become a centre for planned orthopaedic and general surgery, with emergencies being handled in Tunbridge Wells.
Following Mr Johnson's approval, detailed planning for the changes will now begin.