Campaigners have raised fears that the mistakes which led to the Stafford Hospital scandal could be repeated,
They spoke out as Health Secretary Jeremy Hunt was announcing his decision on whether the scandal-hit Mid Staffordshire NHS Foundation Trust should be dissolved.
Mr Hunt has the final say on plans to break up the trust and move key services to neighbouring hospitals.
In January, the health watchdog Monitor approved plans drawn up by administrators to downgrade some services at Stafford Hospital despite opposition from local campaigners.
The main campaign group Support Stafford Hospital (SSH) has criticised part of the proposals which would mean downgrading maternity and paediatric care, and transferring emergency surgery and intensive care beds out of Stafford to neighbouring hospitals.
Cheryl Porter, of SSH, said the group had no issue with the dissolution of the trust and accepted "Stafford cannot stand alone" and should be part of a larger health network with other partner hospitals.
But she said the proposal to "downgrade" to a midwife-led unit, without access to obstetricians, would take the level of maternity healthcare for people living in the area "back 40 years".
"I think there's a big danger of making the same mistakes which were made, albeit in a completely different scenario, whereby what's best for patients is taking a back seat to other considerations," said Mrs Porter.
"And there's talk of doing what they plan to do here at Stafford to other general hospitals around the country."
Mid Staffordshire was the focus of one of the biggest scandals in the history of the NHS when hundreds more people died than would normally be expected.
The Francis Inquiry last year highlighted the "appalling and unnecessary suffering of hundreds of people", with some patients left lying in their own faeces for days, forced to drink water from vases or given the wrong medication.
That followed a 2009 investigation by the Healthcare Commission which found between 400 and 1,200 more people died at Stafford Hospital than would have been expected.
In December, trust special administrators said the overall trust was "unsustainable" and that without changes Mid Staffordshire would face annual debts of more than £40 million by 2017.
It said maternity services at Stafford Hospital should be downgraded rather than closed as originally planned.
A new midwife-led maternity unit will be created at the hospital under the changes, but consultant-led services for more difficult births will be dealt with at the University Hospital of North Staffordshire in Stoke-on-Trent.
Overall control of Stafford Hospital is expected to go to the University Hospital of North Staffordshire while Cannock Hospital will be run by Royal Wolverhampton Trust.
Paediatric assessment will still take place at Stafford Hospital by specialist staff, in conjunction with A&E, and critical patients will be allowed to stay overnight in Stafford as long as the appropriate staff are on duty.
The plans would mean the hospital would keep its current limited-hours A&E department.
Mrs Porter claimed the proposals could mean that any patients with serious conditions faced an ambulance journey to get further treatment.
She said: "We've got an ambulance service working near to capacity, and critical care services being moved away which will place strain on those ambulances.
"We know in maternity that during labour anything can happen - for example the need for a Caesarean.
"So under these plans, suddenly you're faced with having to get that woman out of the hospital, into an ambulance and onto the motorway and out to Stoke or Wolverhampton and all the time the clock is ticking.
"Those are the sorts of scenarios where you can lose baby and mother, or both.
"That is how it used to be in Stafford before this was hospital was built, and it means effectively we are going back 40 years - it's a backwards step for care."
She added: "I do genuinely fear what is coming - you will have specialised hospitals not only dealing with specialised care but also having to cope with carrying out the majority of acute care.
"Of course, we don't want to be proved right because that effectively means patients would be dying, but looking at the scenarios that is my fear."
Local feeling runs high over the debate about the hospital's future and last April more than 50,000 turned out for a huge march through Stafford town centre in support of keeping critical care services on the site.
Mrs Porter said the group would continue to fight to keep what it sees as key services in the town.