Construction work has resumed at a "super-hospital" thrown into limbo for two years by the collapse of construction giant Carillion.
The newly-named Midland Metropolitan University Hospital, in Sandwell, was due to open in 2018.
Work ground to a halt when Carillion went under, leaving the unfinished building to deteriorate.
The hospital is now expected to open in 2022 and building costs are set to almost double from the original £350m.
A report by the National Audit Office said the total costs associated with the project are likely to reach £988m, of which £709m will be met by taxpayers.
Sandwell and West Birmingham NHS Trust Chief Executive Toby Lewis said the restart of construction proper on Friday would "bring jobs back to our community" and would enable local businesses "to plan for their role in our future".
Originally called the Midland Metropolitan Hospital, the addition of the word university is designed to reflect collaborations with higher education establishments in Birmingham and Wolverhampton, as well as Aston Medical School.
Follow BBC West Midlands on Facebook, on Twitter, and sign up for local news updates direct to your phone