St Mary’s Hospital in Paddington could be forced to close after its commissioning body released radical plans for the future of the area’s hospitals.

NHS North West London (NHS NWL), which commissions healthcare in eight boroughs including Westminster, has released a report painting a damning picture of the area’s healthcare.

The report, Shaping A Healthier Future, says more money should be spent on local community health services and less on hospitals.

On Monday NHS NWL medical director Mark Spencer said the future would see fewer hospitals that are larger and more specialised.

Asked if hospitals would have to close, he replied: “Almost certainly. Some of them will continue as diagnostic and outpatient facilities, but it’s likely some of them won’t have hospital beds in them as they do now.”

The report says the changes are “about saving lives, not money” but concedes �1billion needs to be slashed from budgets by 2014/15.

The plans do not reveal which hospitals would be worst affected, but show that Imperial College Healthcare NHS Trust, which runs St Mary’s, has a �19million deficit – the largest of any NHS trust in the area.

An NHS NWL spokeswoman said: “If we are to maintain and improve good quality care for patients in the future in north west London, hospitals will have to change.

“Nevertheless it is not anticipated that any hospital site will cease to offer services. Where possible care will be kept local, but it may make sense to bring some services together and specialise.”

The report says NHS buildings in north west London are generally in a poor stateand “patient experience is generally poor”.

It also reveals “many staff would not be comfortable sending their own relatives to hospitals in north west London”.

Cllr Barrie Taylor, who sits on the council’s health scrutiny committee, said: “People should realise that there will be serious outcomes to this and I have no doubt that local people will want to keep St Mary’s. NHS NWL has got to prove that anything it changes is going to be improved.

“We can’t just assume and accept that they have to make cuts.”

An Imperial College Healthcare NHS Trust spokeswoman said the process is in the early stages and any changes will need to show the benefits to patients.

She added that the trust hopes to break even financially by next year.

The report’s proposals will form the basis of a public consultation starting in June.