THE inpatient dementia ward at Chepstow Community Hospital is set to close by the middle of April, amid fears that continued staffing shortages will compromise patient safety.

A controversial recommendation to approve the closure of the 15-bed St Pierre Ward, as part of a redesign of older adult mental health services across Gwent, was approved by board members of Aneurin Bevan University Health Board today.

A report on the redesign proposals raised concerns about the sustainability of the ward beyond April 14.

And responding to a query about why closure is sought so quickly Dr Chris O'Connor, divisional director of the health board's mental health and learning disabilities division, highlighted the potential staffing position that week.

"The roster within St Pierre Ward would require 12.61 (whole time equivalent) registered nurses and a ward manager," he said.

"From April 14, we would be in the position of having three whole time equivalent registered nurses and a ward manager."

Describing this as a "massive discrepancy in need and availability", he said that three shifts that week would not have a qualified nurse, and the majority would have one registered nurse and bank staff.

Persistent difficulties in recruiting enough nurses for older adult mental health inpatient units prompted the service redesign idea, and board members were told that the situation at Chepstow is not new.

"In any other circumstances we would probably have a lead-in time (ahead of closure)," said health board chief executive Judith Paget.

"We have been managing these pressures for 18 months. This is not a new risk."

Closure of St Pierre Ward was first mooted last autumn, with opposition voiced county-wide during a subsequent consultation.

It is part of plans to remodel mental health services for older adults, that will result in there being three inpatient dementia units at Ysbyty Tri Chwm in Ebbw Vale, St Woolos Hospital in Newport, and Ysbyty Ystrad Fawr in Ystrad Mynach, and at a single functional mental illness unit, at County Hospital, Griffithstown.

Patients who would have used St Pierre Ward will be treated in future at Ysbyty Tri Chwm in Ebbw Vale, or St Woolos Hospital, Newport, depending on where in Monmouthshire they live.

Another key aspect of the redesign will be the development of more community-based services for dementia patients.

Savings of almost £850,000 are expected, through the reorganisation of wards.

A little more than half of this (£429,000) is proposed for reinvestment in community-based programmes, including increased care home in-reach in Monmouthshire, more behavioural support, an increase in psychological therapies in Monmouthshire and Caerphilly, and more dementia support workers.

A further £200,000 is earmarked for core services, to fund an historic shortfall in staffing older adult services generally, and to ensure these are sustainable.

And the health board has today agreed that the remaining savings - more than £200,000 - can be used by the mental health and learning disabilities division, working with Monmouthshire council and the county's third sector, to further support services in the area.

The service redesign proposals attracted far more scepticism and opposition in Monmouthshire than in the rest of Gwent during a three-month public consultation exercise, though there was a widespread recognition among those who participated that change was needed.

Fears over transport and parking difficulties for families and carers who will have to travel to other units were a key source of opposition, in tandem with anger over the loss of a ward at Chepstow hospital that is well regarded.

Aneurin Bevan Community Health Council, Gwent's independent patients' watchdog, backed the plans, having asked for assurances over issues such as parking at St Woolos Hospital, travel for families and carers, and enhanced community services.