The state government has been accused of sneaking through plans to privatise the operation of a further five hospitals across the state.
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More than $1 billion was committed at the last state election to upgrade hospitals at Maitland, Wyong, Goulburn and Shellharbour and for improvements at a fifth, in Bowral.
The government confirmed on Thursday that under its plans private companies would be invited to submit tenders to build and run the hospitals, but said public patients would continue to receive free care.
Health minister Jillian Skinner said the state government was ensuring the sustainability of the health system.
"These communities have been waiting for decades," she said. "Partnering with non-government hospital operators will allow us to maintain quality healthcare while delivering the best value."
But the state opposition has accused the minister of surprising the community and never signalling during the state election any intention to privatise the hospitals' operations.
"On a late Thursday afternoon, the health minister drops a major policy shift without any warning or consultation," said Labor health spokesman Walt Secord. "Without proper protection, we could see the creation of a two-tier health system in NSW."
Current staff who wish to stay on and work for the new operators will be offered a job if an equivalent position can be found, the state government said. Those who leave will be offered a guarantee of two years' employment in the public system.
Plans for a new privatised hospital on the Northern Beaches, set to open in 2018, have been met with protests from unions and some residents.
Under the Northern Beaches model the state government will pay the Healthscope corporation to treat public alongside private patients.
The state government has said it will enter into "market testing" for the rights to operate the new $400 million Maitland Hospital.
Greens health spokesman Jeremy Buckingham said the recent scandal at St Vincent's Hospital, which was found to have misled the state government over the underdosing of chemotherapy patients, has shown there is not enough oversight over private operators.
"They are not accountable to the state government in any way shape or form," said Mr Buckingham. "Their prime directive is to make money".
The state's first trial of the private operation model, two decades ago with the Port Macquarie Base Hospital, ended with it being bought back by the state government.
