Services at Oxfordshire's largest hospitals, including plastic surgery, children's cardiac surgery and neurosurgery, may be axed in a shake-up to improve overall care.

As part of a strategic review for the Oxford Radcliffe Hospitals NHS Trust, health managers have suggested areas of its work may not be financially or clinically viable.

They include services covered by all four of its sites -- Oxford's John Radcliffe Hospital, Churchill Hospital and Radcliffe Infirmary, and The Horton Hospital, in Banbury.

Services like opthalmology, urology and gynaecology are at risk from independent centres, which are being paid by the Government to do the same work.

The future of older people's services is also being questioned, because health managers believe these could be better provided in the community, by primary care trusts.

The same is being suggested for care for patients suffering chronic conditions, like asthma and diabetes.

In a pre-consultation document, called Emerging Themes, the ORH explains it is also reviewing specialist services like neurosurgery and children's cardiac surgery, which are only used by a small number of patients each year.

Marcus Lapthorn, a member of the ORH patient panel, said: "The financial viability of the opthalmology service is threatened with the reduced fee income resulting from the transfer of services to the independent sector.

"I understand that £800,000 has already been cut from this year's opthalmology budget in order to provide a budget to cover the new opthalmology independent treatment centre.

"As there is now a market environment with competition being provided in the opthalmology sector, I note with great concern that the trust may decide to withdraw its service."

Paul Sargent, chairman of the Oxford health overview and scrutiny sub-committee, hoped the review would allow services to be overhauled to the benefit of the community.

He said: "I'd much prefer people to have a decent hospital that provides the services on their doorstep.

"If that's what they're doing in this review then they're doing the right thing, because people will be able to tell them what they want, and the trust will have to listen.

"It does worry me that some services could come under the knife, and I hope any that are cut are provided for us elsewhere as close to home as possible."

A series of public meetings will be held in the next few weeks. Copies of Emerging Themes are available by calling 01865 220351.