The plans for the 670-bed Midland Metropolitan Hospital have been drawn up by Sandwell and West Birmingham Hospitals trust for land in Smethwick.
But they have been hit by delays, prompting officials to apply to extend planning permission for the scheme and work is still not due to begin until 2016.
However bosses at the trust which runs Sandwell, Rowley Regis and City hospitals, remain committed to the project and say until it finally gets off the ground they will be expanding services for patients.
The development is earmarked for Grove Lane and will replace Sandwell Hospital in West Bromwich and City Hospital, in Winson Green.
All of the current properties on the site have now been bought, either through their owners deciding to sell up after hearing of the scheme, or through health chiefs' use of Compulsory Purchase Orders.
And bosses insist the scheme is moving forward.
Toby Lewis, chief executive of the trust, said: "We continue to progress discussions about the potential new hospital.
"If all necessary external permissions are obtained this financial year, then construction would commence in 2016.
"All properties on the Grove Lane site have been acquired by CPO and voluntary acquisition."
Mr Lewis said that in the period from now until work starting, extra efforts were being made to make sure existing healthcare provision could be expanded for patients.
He added: "Meanwhile, we are working with partners to expand services in general practice and in community settings. New services have moved into Rowley Regis and the Portway Lifestyle Centre in recent weeks and we are looking to move the majority of clinics for diabetes into primary care settings over this winter.
"The great benefit for local patients of the proposed Midland Metropolitan Hospital is that it concentrates acute specialist care.
"This means that scarce, highly skilled clinicians will be available to look after the sickest patients more quickly, seven days a week, day and night.
"That is what we believe is needed, as soon as possible, for the half a million people who need our care. This can only be achieved with one major emergency department, supported by local urgent care centres."
The hospital is due to take up 16 acres on Grove Lane but a further 31 acres of land between Grove Lane, Cranford Street, Heath Street and Dugdale Street is to be transformed and filled with other employment opportunities and housing schemes.
Sandwell Council has already adopted those multi-million regeneration plans, which had been the subject of extensive consultation and dubbed the Grove Lane Masterplan. Bosses at the trust say the project will provide construction jobs, replace poor buildings in the Smethwick area and release parts of the City and Sandwell hospital sites for redevelopment.
A bus hub may also be included in the regeneration scheme.
Centro is looking into the need to build as the influx of hospital workers into areas surrounding the scheme would place extra demand on existing services.
And it not just the future where bosses are focusing their attention. The trust was recently ranked among the better performing of NHS trusts across the UK.
It was placed in band four of a six-band table by the Care Quality Commission, with band six trusts being those with the lowest levels of concern.
The trust is also proactively pioneering a scheme which could change the lives of those teenagers in its area who are homeless.
It is spending £600,000 refurbishing an old accommodation block to help launch its Homeless Prevention Programme, aimed at getting 16 to 18-year-old homeless people employment within the trust through its apprenticeship scheme.
So whether it is now or in the future – health chiefs in Sandwell have plenty to shout about.