A£76.5m hospital on a greenfield site has been proposed in consultation on the future of acute services launched by Northern Ireland's Western health and social services board.
The new hospital would mean closing existing acute hospitals in Omagh and Enniskillen, scenes of two of the most devastating bomb tragedies in the province.
The proposal, together with two further options to maintain at least one inpatient hospital in the southern part of the board's area, conflicts with the view of Northern Ireland health minister John McFall that Northern Ireland has too many acute hospitals for its population.
But consumer services manager Michael Gormley said the minister had encouraged the board to continue its review of acute hospitals when he published his own analysis, Putting it Right, in December.
Mr Gormley added that the proposals were broadly in line with Mr McFall's own 'vision' of a network of local hospitals with links to area and regional hospitals.
The greenfield site is the preferred option of an independent steering group set up to examine how to secure high-quality acute services over the next 10 years.
But Western board has decided not to recommend any of the options until the consultation ends in June.
The steering group found that, in addition to Altnagelvin Hospital in the north, a local acute hospital with a range of core specialties, including an accident and emergency department and a maternity unit, was needed in the south.
This could be provided by building a new hospital, or by enhancing either the existing Tyrone County or Erne hospitals. Both are run by Sperrin Lakeland trust, which dealt with the immediate aftermath of the Omagh bomb. The new hospital would be cheaper, costing£76.5m to build compared with£83.5m to enhance Tyrone County and£79.5m for Erne.
Nine of the 12 sub-groups set up to look at specific aspects of hospital services recommended the greenfield site. The advantages claimed for it include providing appropriate modern facilities, single-site working for clinicians, and the best access for most people to emergency services.
The consultation document accepts that the current strategy of Sperrin Lakeland trust is 'vital in the short to medium term' to sustain services in the southern sector until a longer-term solution can be realised.
This involves developing a 'one hospital service' on two sites with a range of core and specialist inpatient services between them.
See news focus, page 16.