HEALTH bosses in Gwent have been - and remain - coy on the issue of whether a replacement hospital for the Royal Gwent could or should be built on the former Corus site at Mendalgief Road.

That the Royal Gwent is living on borrowed time is beyond dispute and Gwent Healthcare Trust has already publicly stated that the hospital will need to be replaced in the next ten years.

But though the Royal Gwent is the area's biggest hospital and among the busiest in Wales, it is just one part of a complex network of hospitals of varying functions and sizes across Gwent.

Its replacement is being seen by health bosses in the context of a Strategic Investment Plan (SIP) for Gwent - a vision for hospital services in the area for the next 20-25 years.

Originally driven by the trust, Gwent's five new Local Health Boards (LHBs) are now involved and beginning to think about the future shape they wish hospital services to take in their respective areas.

Replacements for Gwent Health Authority, as part of a restructuring of the NHS in Wales in April, Gwent's LHBs - Newport, Torfaen, Blaenau Gwent, Caerphilly and Monmouthshire - are responsible for commissioning health services for their respective areas.

Each will draw up a wish-list of services for the SIP, while the trust takes a pan-Gwent view of hospital service planning. These blueprints will then need to be combined and adapted to provide a single vision for the NHS in this area.

Work has barely started on these blueprints, and they will need to take into account existing proposals for hospitals, such as the community facility proposed for Blaenau Gwent in Ebbw Vale, and tentative plans for replacing Caerphilly District Miners Hospital.

They must also incorporate the ideals and aims of the Assembly's Better Health, Better Wales programme, and the recent Wanless Report into health and social care in Wales.

What is especially exciting about this attempt to devise a new template for hospital services is that it starts with the services that healthcare planners - with the benefit of input over several years from clinicians, statisticians and the patients themselves - believe Gwent needs.

It is not based upon moulding services to fit existing buildings or ways of working, but largely assumes a blank-sheet-of-paper approach that devises the services first, then proposes the facilities in and with which to deliver them.

This is a strength, in that it pre-supposes nothing and allows the construction of a best case scenario system.

But its weakness is that it has no firm basis in terms of funding, siting, and planning.

Also, new hospitals do not come cheap. The Blaenau Gwent project will cost £36 million and that is a 115-bed, community-style facility.

Providing an acute hospital with all or most of the facilities currently available at the Royal Gwent could cost upwards of £350m. If the facilities lost from St Woolos and St Cadoc's could feasibly be included on the same site, and that is open to question, the cost could be even more.

Also, there is no guarantee the Assembly would give such a proposal its blessing.

Recent experience in Gwent concerning masterplans for ex-steelworks sites and hospitals, should also provide a warning for planning visionaries.

The proposed Blaenau Gwent community hospital was included in a masterplan for regenerating the Corus tinplate works site in Ebbw Vale, but health bosses eventually opted for an alternative site in the town, as the masterplan site did not meet the rigorous standards required for the location of a hospital.

Briefing notes from Newport Unlimited's community workshops on the masterplan stress the need to engage health bosses and "integrate their future planning into the masterplan".

The sooner the dialogue starts, the better.