經營特爾福德醫院和皇家什魯斯伯里醫院的Shrewsbury and Telford Hospital NHS Trust (SaTH)表示，它正在努力 "解決長期存在的重複和分散的服務問題，因為老化的基礎設施不適合提供21世紀的醫療保健"。
第二種方案使什魯斯伯里成為急診醫學和婦女兒童服務的基地，同時在特爾福德留下一個 "緊急護理 "中心，以取代其目前的急診部門。
The reorganisation of Shropshire's hospitals is likely to go ahead but without some of the proposed changes due to funding issues, a report says.
Complaints by critics of the scheme include fears that losing A&E at Telford's Princess Royal Hospital is a downgrade that jeopardises safety by leaving those in the town with further to travel for emergency care.
Shrewsbury and Telford Hospital NHS Trust (SaTH), which runs the Telford site and Royal Shrewsbury Hospital, says it is trying to "resolve longstanding issues of duplicated and fragmented services in an ageing infrastructure that is not fit for delivery of 21st century healthcare".
SaTH's Strategic Outline Case for the overhaul of services sets out four possible options for the transformation process, first put forward in 2013.
The report says the first option, continuing with the current model, will fail to meet the trust's aims, which are to improve efficiency, reduce workforce duplication between sites, adapt to changing population needs and increase capacity.
The second option makes Shrewsbury the base for emergency medicine plus women and children's services, while leaving an "urgent care" centre in Telford in place of its current A&E department.
Under that plan, Telford would become a base for planned care, with the report saying the changes at both sites can mostly be accommodated within the existing buildings and meet the budget of £312m set by the government.
The third option, which the report said would cost a budget-busting £481m, would also involve the creation of new beds, education and training areas, improvements to chemotherapy treatment and upgraded operating theatres.
The fourth option is said to cost £534m and adds improvements to outpatient provision and the creation of a health and wellbeing centre in Telford.
The report added, however, that options three and four would continue to be explored, but it concluded the second option should be the preferred way forward because it would fit the available finances.
SaTH said it would spend the next 12 months drawing up an Outline Business Case, taking feedback from staff and residents of the area.