Radical changes are on the cards for many Gwent hospitals, with an overhaul of services being planned in preparation for the opening of the £350 million Grange University Hospital. ANDY RUTHERFORD reports

THE Royal Gwent and Nevill Hall Hospitals will adopt new roles when the new Grange University Hospital opens in 2021 - but service reorganisation will also take in other sites both old and new.

And the process will provide Aneurin Bevan University Health Board with the opportunity to tackle the difficult and eye-wateringly expensive issue of repair and maintenance across its estate, and under-used, empty and sub-standard facilities.

The Grange, at Llanfrechfa near Cwmbran, will treat the sickest patients from Gwent and south Powys, with the Royal Gwent, Nevill Hall and Ysbyty Ystrad Fawr becoming enhanced Local General Hospitals.

The latter is less than 10 years old and was purpose-built to meet the demands of 21st Century healthcare, but the Royal Gwent and Nevill Hall present major challenges in terms of upkeep and adaptation.

The health board's draft estates strategy states that, across the whole NHS estate in Gwent, the backlog repair and maintenance bill is £108m, of which almost a quarter (£25.5m) is classed as high and significant risk.

The overall bill is deemed "unacceptable", and there is an acknowledgement that the high and significant risk element must be "prioritised and addressed".

Of that £25.5m, £17.5m relates to issues at the Royal Gwent and Nevill Hall, not surprising given their size and the age of large parts of each site.

Overcrowding and insufficient car parking are longstanding issues at both hospitals, and considerable investment will be required to support their new roles.

For Gwent's older hospitals too - such as St Woolos, County and Maindiff Court - under-use and the poor condition of some buildings are pressing issues, and changes in services may be profound after the Grange opens.

Ten per cent of Gwent's NHS estate is classed as under-used, with three per cent empty. Much of this relates to hospital sites, notably in the mental health and community sectors.

The Royal Gwent Hospital

The most profound effect of reorganisation will be at St Woolos Hospital, from which inpatient services - rehabilitation, orthopaedics, mental health and dermatology - will switch to the Royal Gwent after the Grange opens and in turn, some services currently based at the Royal Gwent will move there.

Other services at St Woolos meanwhile, will either move into the site's newer Casnewydd Unit or again, to the Royal Gwent. This will leave large parts of the St Woolos site empty, and it remains to be seen what the future holds for these.

St Woolos Hospital

The hospital currently costs £5.3m a year to run, with a high and significant risk backlog, of £2.4m. Older parts of the hospital are described in the draft estates strategy as "under-utilised, inappropriate and in poor condition".

Similar issues exist at County Hospital in Griffithstown, with most of the site described as "inappropriate and in poor condition", with some "under-utilised/empty". The hospital costs almost £2m a year to run, with a high and significant risk backlog of £778,000.

County Hospital

The report acknowledges the situation must be addressed, but that more work is required to determine what services should be provided there in future.

"Significant replanning" is needed for the St Cadoc's Hospital site at Caerleon, too. The hospital has a high and significant risk backlog of £1m, and 13,000 square metres of empty space, but remains the main site for specialist mental health and learning disability services, and houses the health board headquarters.

Under-used and empty space is also a major issue at Maindiff Court Hospital, outside Abergavenny, described as "largely not of the expected standard for clinical services". It has a £320,000 high and significant risk backlog.

Electro-convulsive therapy services are set to move from there to Nevill Hall after the Grange opens.

There are issues to solve at newer hospitals too. Ysbyty Tri Chwm in Ebbw Vale is less than 20 years old, but has a high and significant risk backlog of £320,000 and its 15 beds for dementia patients are set to move to Nevill Hall after the Grange opens.

"The future use of this facility for mental health services only, and its potential to be used for other primary care/community services, needs to be explored," states the strategy.

Services at three other sites - Ysbyty Aneurin Bevan in Ebbw Vale, Chepstow Hospital, and Monnow Vale at Monmouth - are likely to remain largely as they are at present.

Chepstow Hospital

But Chepstow and Monnow Vale are leased facilities, built and opened in the early 2000s under the Private Finance Initiative, and the lease arrangements will be reviewed to ensure "value for money is being obtained".