The SHA has identified a package of measures to save �155m

The East of England Strategic Health Authority (SHA) is looking at a major shake-up of hospitals in the region.

It is considering centralising some clinical services in "super" hospitals rather than providing the care in several district hospitals.

But the plans could hit the care provided, the union Unison has said.

The SHA is also looking at cutting the number of sites providing emergency care.

Dr Paul Watson, director of commissioning for the SHA, told the BBC 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

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.

Geoff Reason, of Unison, said: "There's been rumours of such a review for some time, but this is the first time we've seen it publicly.

"We are really concerned because it possibly could result in a huge reduction in the level of services in the east of England."

Dr Watson said the review was meet the challenges of the 21st Century.

"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."