GWENT's proposed Specialist and Critical Care Centre (SCCC) could be among only four or five hospitals across South Wales to deliver key specialist services such as A&E and neo-natal in future.
The region's NHS bosses and doctors believe these services, along with obstetrics and paediatrics, are too thinly spread across nine hospitals stretching as far west as Morriston in Swansea.
Patients, public and NHS staff are being invited to take part in what health boards hope will be a vigorous debate over the next three months about where these services should be based.
Challenges facing hospitals across South Wales - and potential ways of meeting these challenges - are contained in a report called ‘Matching the Best in the World’.
It reveals that problems in finding enough staff to cover these services as they are currently set up means expert standards are increasingly difficult to meet.
Too much dependence on locum doctor cover is a big issue, and at some hospital sites too few patients are seen on an annual basis for staff to develop or maintain key skills.
The Royal Gwent Hospital in Newport and Abergavenny's Nevill Hall are among nine hospitals across South Wales currently delivering all or some aspects of A&E, neo-natal, paediatric and
In Swansea there are Morriston and Singleton Hospitals, in the Cardiff area the University Hospital of Wales (UHW) and Llandough, in Bridgend the Princess of Wales Hospital, in Merthyr Tydfil
Prince Charles Hospital, and in Llantrisant the Royal Glamorgan.
Consultants and doctors - more than 300 have been involved in cross-health board discussions - believe four or five centres are enough to provide A&E, obstetrics, paediatrics and neo-natal
UHW, Morriston and the proposed SCCC for Gwent at Llanfrechfa are three. It is further proposed that four or five hospitals provide Level Two (high dependency) neo-natal care, with just two or
three providing Level Three (intensive) neo-natal care.
The SCCC proposal would see such services in Gwent centralised in one hospital, though this is a project several years away, and has yet to leave planners' drawing boards.
Given existing pressures, interim reorganisation of some of these services within Gwent may be necessary.