MULTI-million pound plans to modernise Gwent's hospital services will be vital in preventing massive disruption for thousands of patients and staff, say health bosses.
Gwent Healthcare Trust chiefs fear the area's existing hospital system is close to meltdown, the case for major new projects such as a centrally-located Specialist and Critical Care Centre (SCCC) and a Local General Hospital (LGH) for Newport, more urgent than ever.
Without them, and without others proposed later for north Monmouthshire and Torfaen, patients face fundamental reorganisation of hospital services by default inside five years.
Nevill Hall Hospital, Abergavenny, would most likely lose much of its A&E and obstetrics services, and all intensive care, children's inpatient, and neo-natal services to the Royal Gwent, which in turn would have to re-route most of its routine operations to Nevill Hall to cope.
All emergency and trauma surgery might also have to come to the Royal Gwent.
The main reasons are the introduction next year of maximum 48-hour weeks for junior doctors under the European Working Time Directive, and lack of a critical mass of cases in many specialties at two hospital sites, particularly Nevill Hall, to enable them to develop sufficient skills and expertise.
The working time issue is likely to mean there are not enough doctors, and recruitment of more could prove difficult, even if money could be found to employ them.
Detailed proposals for the SCCC and Newport LGH, which together will cost £436m and provide more than 800 beds, are on the way to the Assembly for scrutiny.
The existing Llanfrechfa Grange Hospital site and the former Whiteheads steelworks site in Newport have been formally chosen as preferred options for the SCCC and LGH respectively.
The projects are the two biggest in the ambitious Clinical Futures programme, which aims to deliver six new hospitals for Gwent over the next seven-eight years.
The aim is to have both open by the end of 2013.
A travel times analysis carried out for Newport Unlimited indicated that this would be the best site for patients across Gwent, but a similar exercise done for Gwent Healthcare Trust identified a central Gwent location and the Llanfrechfa Grange Hospital is now the trust's preferred option.
A review of these analyses has been carried out for Assembly health minister Edwina Hart and she will make a decision based on the details contained in the proposals for each hospital - the outline business cases - which are now heading her way.
