MAJOR and controversial changes to stroke services in Gwent are set to begin next month.

The closure of Cedar Ward, an inpatient rehabilitation ward at County Hospital in Griffithstown, scheduled for mid-August, marks the first stage of a move towards rehab at home for hundreds of stroke patients a year.

It is due to be followed in October by the setting up of a hyper-acute stroke unit (HASU) at the Royal Gwent, providing patients from across Gwent with the emergency care needed during the first three days after a stroke.

A second inpatient rehab ward - Ebbw Ward at Ysbyty Aneurin Bevan in Ebbw Vale - is also set for change in October, though Aneurin Bevan University Health Board is stressing it will not close at that point.

Inpatient rehab and orthopaedic rehab will move to the hospital's Tyleri Ward. The health board intends to use Ebbw Ward to provide extra capacity if required during busy periods next winter, though it is still considering what role the ward will play after that.

The changes will see hyper-acute stroke care centralised in the new Royal Gwent unit, which should be fully operational by December.

This will be supported by 'step-down' acute stroke care (four-seven days post-stroke), at the Royal Gwent and Nevill Hall Hospitals, and Ysbyty Ystrad Fawr in Ystrad Mynach.

But inpatient stroke rehabilitation will be provided in future at just three sites - Nevill Hall, Ysbyty Ystrad Fawr, and St. Woolos Hospital in Newport - instead of seven.

Around a third of the 900 people admitted to hospital in Gwent every year having suffered a stroke, will subsequently spend less time in hospital and receive their rehab at home.

The health board continues to stress that the changes are based on clinical evidence, that patients who have experienced a mild to moderate stroke show much better improvement with rehab at home, while at the emergency end of the stroke care spectrum, the aim of the HASU is to create a centre of excellence.

The proposals, particularly those involving Cedar and Ebbw Wards, the latter comprising a third of the beds at a hospital barely five years old, have raised concerns from staff and from patients and relatives, but have been approved by Aneurin Bevan Community Health Council, the area's independent health watchdog.

Management will hold one-to-one meetings will held with staff in the next few weeks, to discuss the changes.

No job losses will result, but a change of ward or hospital site will be necessary for some staff.