Two trees and a listed wall have come down at Oxford's John Radcliffe Hospital to make way for buses.
Residents in Headington had opposed their removal from the Osler Road entrance to the hospital.
But the Oxford Radcliffe Hospitals Trust said they had to make way for a bus-only road that will link the hospital to London Road.
The trust said the creation of two new bus routes to the hospital was a city council requirement when it applied to build the children's hospital and the new west wing.
Dave Edwards, the trust's transport and planning manager, said: "The last thing we wanted to do was cut down beech trees, but we could not avoid it. We have held regular meetings with residents and everything has been done with full planning approval."
He said the listed wall would be substantially rebuilt.
But Lesley Maddock, former secretary of the Friends of Old Headington, said: "I think this is an affront to the village. We had been assured when it had first opened as a gateway, that it would only be used by cyclists and pedestrians."
Efforts to improve transport links to Headington's hospitals are being introduced in the run-up to services and 1,200 staff being transferred from the Radcliffe Infirmary to the John Radcliffe site in 2007.
Oxfordshire County Council said the route taken by the No 13 bus would be extended to Oxford railway station. It was also hoped that an express service from Abingdon to the JR, via the city centre, could be reinstated.
In addition to bus-only roads, there are plans to increase parking spaces for John Radcliffe patients and staff from 500 to 800.
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