Campaigners have battled to save smaller hospitals in Suffolk

The East of England Strategic Health Authority (SHA) is looking at how to "meet the demands of the 21st Century".

The SHA wants to look at centralising some clinical services in one "super" hospital rather than providing the care in several district hospitals.

It will also look at cutting the number of sites providing emergency care.

Dr Paul Watson, director of commissioning for the SHA, told BBC Look East he could not rule out the downgrading or even closure of any of the 19 hospitals in Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk.

Nine smallest hospitals in debt Queen Elizabeth, King's Lynn, Norfolk Hinchingbrooke, Cambs Bedford West Suffolk Lister, Stevenage, Herts Princess Alexandra, Harlow, Essex Watford, Herts QEII, Welwyn-Hatfield, Herts Hemel Hempstead, Herts

"Healthcare is changing almost daily, and medicine today is very different from 40 years ago," he said.

"Modern clinical standards demand that some services need a much larger caseload than exists in most district hospitals in order to guarantee the best possible clinical outcome (because, for example, the doctors will be more experienced at treating the condition).

"Clinical services need to be centralised in a hospital which would serve the catchment area of several of the current hospitals."

He said the best hospitals for treating cancer serve a catchment area of at least one million people.

The review will also look at whether some hospitals are too small to cover the costs required to provide comprehensive hospital services.

The SHA said that of the 10 smaller hospitals in the East of England, only the James Paget Hospital, in Great Yarmouth, Norfolk, does not have significant financial difficulties.

One of the most vulnerable hospitals in any review is Hinchingbrooke Hospital in Huntingdon, Cambridgeshire.

It is the smallest district hospital in the east yet has the largest debt - with a �24m deficit.