NEWPORT'S Royal Gwent Hospital (pictured) will need to be replaced in the next ten years, say health chiefs.

And they are proposing a massive shake-up of services, likely to cost tens of millions of pounds.

Replacement of one of Wales' biggest and busiest hospitals is one of the anticipated recommendations of an as yet unfinished Gwent-wide blueprint.

Such a move is already being planned for Caerphilly District Miners Hospital, and this is also likely to be a key part of the plan, along with substantial development of Nevill Hall Hospital at Abergavenny.

A Strategic Investment Plan (SIP) for Gwent, a vision for the hospital sector for the next 20 years, is being drawn up by Gwent Healthcare Trust and Gwent's five new Local Health Boards.

Few details are yet being released.

There is no indication of whether the current hospital might be retained in some form, where replacements might be built, or how much it will cost.

But the sketchy details that have emerged point to this being the most fundamental shake-up of healthcare services in Gwent since the formation of the NHS.

The SIP is discussed briefly in a section of the outline business case (OBC) for expansion of orthopaedic services in Gwent, based on projects at St Woolos Hospital, Newport, and Nevill Hall.

"The plan is likely to propose radical changes to acute services in Gwent," states the OBC report. These include:

l More use of "local hospitals" to step up and step down from acute care;

l Centralisation of emergency and specialist services.

"It is anticipated that as a minimum, both the Royal Gwent Hospital and Caerphilly District Miners Hospital will need to be replaced in the next 10 years, with substantial development of Nevill Hall Hospital to support future service requirements."

In the meantime, however, urgent steps must and are being taken to address serious capacity problems, particularly in specialties such as orthopaedics with extra orthopaedic consultants, operating theatres and beds to bridge a big capacity gap and slash waiting times. The schemes will be provided at St Woolos and at Nevill Hall. Capital and other costs total almost £14m.

* With more than 700 beds, the Royal Gwent is one of Wales' biggest and busiest hospitals - but health bosses appear set on pursuing a radical solution to difficulties caused by its site.

Space is so restricted that soon, any major new development will not be accommodated without something else having to be knocked down to make way for it.

Work will begin during the next couple of years on a new cardiology unit and an expanded maternity unit, both multi-million pound projects.

But these will be built on top of existing buildings, the urology department, and the Belle Vue Restaurant respectively. Car parking too, is a chronic problem, exacerbated during recent preparatory work on the hospital's new medical admissions unit, when restrictions had to be brought in.

The loss of more than 20 - albeit restricted - parking spaces on the section of Cardiff Road fronting the hospital, to make way for a bus lane extension, has worsened the situation.

Fundamental reform of the way the NHS in Gwent serves its patients is also at the root of the changes being considered.

A greater separation of elective and emergency care is considered vital if the growing demands of emergency medical admissions are not to continue to infringe on non-urgent surgery.

The effect of such pressures on orthopaedic surgery has hogged the headlines in recent months, but many other patients have regularly had surgery cancelled because there no beds available. The proposed expansion of orthopaedic services will in the short to medium term provide more separation, but the long-term plan is for even more.

There is also a recognition that patient pathways - how a patient passes through the healthcare system from referral to a specialist to treatment, or from admission to hospital until discharge - must be less complicated.

The geographical and functional make-up of hospital services in Gwent is recognised as not always benefit patients and staff.

The SIP's key aims indicate that each clinical service provided by the hospital, or secondary care sector in Gwent will need to be remodelled.