Health bosses have approved changes that will see a reduction in maternity, stroke and children's services at South Tyneside District Hospital.
The reorganisation means more patients will instead be treated at Sunderland's Royal Hospital.
Hospital managers insist the moves are necessary in order to maintain patient safety.
However, campaigners called it a downgrading of services in South Tyneside.
At a meeting in Hebburn, Sunderland and South Tyneside clinical commissioning groups agreed all acute stroke services will be based at Sunderland from April 2019.
A midwifery-led birthing centre will operate at South Tyneside but the hospital's special care baby unit will close with all "high-risk" deliveries admitted to a consultant-run department at Sunderland.
'Can't get workforce'
A nurse-led paediatric minor injury and illness facility will run at South Tyneside between 08:00-22:00 with a round-the-clock emergency paediatric department operating at Sunderland.
Dr David Hambleton, of South Tyneside Clinical Commission Group, said "no change wasn't an option" and pointed to difficulties recruiting staff and financial issues as being determining factors.
He added: "We know people would've liked to keep these services exactly as they are, but unfortunately that's not possible - largely because you can't get the workforce."
Gemma Taylor, a campaigner with the Save South Tyneside Hospital group, said the decision was "pre-determined" and left her feeling "vulnerable".
"We're not saying there couldn't be change, but with modern technology staff could work across both sites," she told BBC Newcastle.
"If they'd involved staff from the beginning I think the options could've been a lot different."
'Grossly let down'
Labour MP for South Shields, Emma Lewell-Buck, reacted with dismay.
In a tweet, she said the people of South Shields and South Tyneside had been "grossly let down".
The people of Shields & South Tyneside as a whole have been grossly let down by those tasked with looking after our healthcare. Shame on anyone who had the ability to & has chosen not to robustly fight for our Hospital. This is not the end @SaveSTHospital— Emma Lewell-Buck MP (@EmmaLewellBuck) February 21, 2018