KEY hospital-based services in Gwent are becoming increasingly 'fragile' due to staffing issues that can only be dealt with through the long-awaited Specialist and Critical Care Centre (SCCC) project, according to a health board report.

Bringing together a range of under-pressure services on one site will be the only means of addressing problems caused by a lack of specialist staff, reduced training numbers, and a need to reduce the amount of on-call shifts for doctors.

A number of these services continue to be provided at both the Royal Gwent and Nevill Hall Hospitals, and Aneurin Bevan University Health Board is looking at ways of maintaining them in the four years before the SCCC is due to open.

But it is warning that this is likely to prove very expensive, and is unsustainable beyond the short term.

Much depends too on the demands of the Wales Deanery, which oversees doctors' training and education, and which is pursuing a new on-call rota system that it wants in place by next August.

Among the services in Gwent that are considered fragile are paediatrics, neonatal, and obstetrics and gynaecology, currently provided at the Royal Gwent and Nevill Hall.

A lack of middle grade doctors - not a problem confined to Gwent, indeed Wales - is making staffing shifts increasingly difficult.

Short term, the health board is aiming to deliver safe and sustainable services at both hospitals with one solution being to employ 'hybrid consultants' - offering middle grade doctor cover as well as consultant-led work.

The health board's full business case report for the SCCC states the 14 of these are proposed across the aforementioned specialties to fill staffing gaps, but the health board is stressing that this is only an interim solution, not least due to the cost, but also because hybrid consultants are likely to leave when traditional consultant posts become available.

There is too a significant degree of interdependence between these three specialties, and between some of them and others, such as critical care.

For instance obstetrics must be co-located with neonatal and critical care due to the needs of premature or very sick babies for the expertise of staff - and the facilities of - each.

Emergency general surgery is another fragile two-site service, considered unsustainable due to a reduction in middle grade medical training places, which affects the ability to have out-of-hours cover on more than one site.

Trauma service rotas at both hospitals too, are failing to meet the Deanery standard, a potential reduction in junior training posts will, says the report, make rotas "very difficult" to fill.