REGIONAL health bosses yesterday approved a controversial report that brought a major hospital shake-up a step closer.

It means the plan drawn up by health expert Professor Ara Darzi now looks likely to go through, despite objections from local coun- cillors, a protest march and a petition signed by 20,000 people in the Stockton area.

Opponents of the changes are particularly concerned that it will lead to the downgrading of the University Hospital of North Tees' maternity unit to a midwife-run unit.

Yesterday, County Dur-ham and Tees Valley Strategic Health Authority (SHA) backed virtually all the provisions of the Darzi plan.

NHS officials say that hospital services have to adapt to changing circumstances if they are to survive.

David Flory, chief executive of the SHA, said: "No change was never an option because the current spread of services was not sustainable."

When it was announced last year, the Darzi plan was greeted with acclaim in Hartlepool, where it is seen as guaranteeing the future of the local hospital. However, the plan was met with hostility in Stockton, where it is seen as undermining services in favour of Hartlepool.

Put together by a Government-appointed health expert, the plan would mean the University Hospital of Hartlepool would keep accident and emergency, acute medicine and critical care services, but lose emergency surgery to North Tees hospital, in Stockton.

Hartlepool would also become a centre of excellence for women's and children's services. In exchange for becoming the main centre for emergency surgery and complex cancer surgery, the North Tees hospital would lose its special care baby unit and its consultant-led maternity and paediatric units.

The next step is for the SHA to respond to the Joint Overview and Scrutiny Committee's view on the plans.

The committee, which represents councils in the area, objects to the proposed changes for obstetrics and paediatrics and has the right to call in the Health Secretary, Patricia Hewitt, to examine the plans. Last night, Stockton Borough Council leader Councillor Bob Gibson vowed to continue the fight.

He said: "The Darzi report was flawed from the beginning and it is still wrong. We have already got a centre of excellence for women and children at North Tees. What is the point of closing it down? If necessary, we will go out and collect another 20,000 signatures against these proposals."