A 15-BED dementia ward at Chepstow community hospital is earmarked for closure under plans to redesign mental health services for older adults in Gwent.

Patients using St Pierre Ward would - if its closure is approved - be treated in future at Ysbyty Tri Chwm in Ebbw Vale, or at St Woolos Hospital in Newport, depending on where in Monmouthshire they live.

Persistent difficulties in recruiting enough nurses to staff older adult mental health inpatient units prompted the redesign idea.

But Dr Patrick Chance, clinical director of Aneurin Bevan University Health Board's older adult mental health services, told board members the "vast majority" of work is community-based.

The situation, he said, presents "a real opportunity for creating more community-based services, which we will have to do to meet future demand. We also want to move to having specialist centres of excellence for inpatient services."

"We see Sycamore Ward (at St Woolos) as our inpatient centre of excellence, and want to emulate and develop that model," he said.

He acknowledged that closing St Pierre Ward will result in travel difficulties for Monmouthshire patients, and that the issue will have to be explored during a forthcoming consultation on the proposals.

If St Pierre Ward does close, the hospital will still contain a rehabilitation ward, two GP practices, a dental practice, a five-days-a-week outpatients service, diagnostic radiology, nurse- and therapies- led clinics, and a day hospital.

Opened in 2000, Chepstow community hospital was built under the private finance initiative. The arrangement - where capital projects such as roads and hospitals are built with repayable loans from the private sector - has 10 years to run.

Health board chairman Ann Lloyd has set up a working group "to consider potential uses in the future of facilities in Chepstow hospital." This will report in nine months.

Should St Pierre Ward close, Gwent will have three dementia units - at Ysbyty Tri Chwm in Ebbw Vale, St Woolos Hospital in Newport, and Ysbyty Ystrad Fawr in Ystrad Mynach - and a single functional mental illness unit, at County Hospital, Griffithstown.

This would involve a total of67 beds, five fewer than at present, but requiring 11 fewer nurses.

Recruitment difficulties prompted a reduction from 92 to 72 beds overall in January last year.

There remain 14 vacancies to maintain 72 beds, let alone to return to 92, as originally intended. But the service has coped with reduced bed numbers in terms of patient demand.