THE possibility of Gwent's new Grange University Hospital opening as early as November - instead of next spring - is the result of an extraordinary response to unprecedented circumstances.

The first Covid-19 case in Wales was confirmed on February 28 and within a month the NHS here was facing the threat of being overrun.

Part of the response, as critical care units and hospital beds filled up with patients, was to create extra capacity in the form of field hospitals across Wales.

But the Grange offered the prospect of something a little different - a hospital in the true sense of the word, albeit towards the end of last March around a year away from its scheduled opening date. Crucially though, building work was sufficiently advanced to offer the prospect of - with an extra £10 million funding and a re-focusing of priorities - being made ready to accept patients within a matter of weeks.

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Plans were made for part of the Grange to be readied by the end of April to take up to 350 patients should the feared surge of Covid-19 cases overwhelm other hospitals in the area.

Gwent was Wales' Covid-19 hotspot for several weeks and there was for a while a real prospect of the extra beds being needed.

In the event, by the time those Grange beds were patient-ready, the initial threat of the hospitals in Gwent being overwhelmed had receded, and they were not required. But the acceleration of work on parts of the hospital presented an opportunity to press on further.

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A bird's eye view into one of the under-construction courtyards at the Grange University Hospital. Picture - Aneurin Bevan University Health Board

Winter is when the NHS in Wales - indeed, across the UK - is traditionally tested to its limits. But next winter, even if a second spike of Covid-19 does not present itself, must be planned for and managed in the context of the virus and the challenges it presents to healthcare and the safety of patients and staff.

Thus, plans have been developed to build on the work already fast-tracked at the Grange, to enable it to open in November and provide the extra capacity necessary for a first winter in which Covid-19 must be factored into preparations.

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A November opening for the Grange University Hospital remains only a possibility at present, because while the health board has approved the idea, the final decision - along with the need to provide a further £17.4m to cover the costs of an earlier than planned opening - rests with the Welsh Government.

But a tour of the finished areas of the hospital gives an indication of why the health board is keen to open it prior to, rather than after, next winter.

For this is where the key principles on which the idea of the £350m Grange University Hospital and the Clinical Futures healthcare modernisation programme in Gwent, of which it is a key part, come into their own.

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A critical care unit room at the Grange University Hospital

Before it acquired its name, the Grange was described as a specialist and critical care centre, and that remains its role. It will treat Gwent's sickest patients, those in need of emergency and complex treatments and care.

This enables the separation of emergency and elective treatments, with the latter being provided in hospitals such as the Royal Gwent, Nevill Hall, and Ysbyty Ystrad Fawr.

It will also centralise key specialties, some of which - including A&E, obstetrics and paediatrics - have workforce issues which have meant that sustaining them on two hospital sites has been challenging for some time. Stabilising staffing levels, particularly going into another busy winter, is seen as vital.

The Grange will also house 75 per cent of its beds in single rooms, a major advantage in helping reduce the risk of infection - and all will have a view, either of the surrounding countryside or a courtyard.

Even the critical care unit will house its patients in single rooms, a major change to the traditional multi-bed set-up of such units - including at the Royal Gwent - that has been a common sight on TV news coverage during the Covid-19 pandemic.

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"We are planning to open all our beds and all our facilities - there would just be some smaller services that would not move into the Grange until next spring," said Nicola Prygodzicz (above), director of planning, digital and IT at Aneurin Bevan University Health Board.

"There will be 80-85 per cent (in November) of what was planned for next spring - including stroke care, cardiac care, main A&E, obstetrics, paediatrics, neonatal - everything needed as part of the winter and Covid-19 response.

"It's a huge task, but the opportunity this brings in terms of being ready for the winter outweighs the risks of acceleration.

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Dr Chris Chick (above in one of the critical care rooms), an interventional radiologist, who is also the clinical lead for the Clinical Futures programme, said the Grange will enable a better response through the winter and beyond.

Key departments - such as A&E (adults and children), critical care and medical assessment units, coronary care - are situated in a proximity to each other that allows for a smoother treatment journey for acutely unwell patients from the moment they enter the emergency department.

CT and MRI scanners will also be located in the emergency department, a rare co-location in UK hospitals.

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"Most people will not come to the Grange because they will not need to," said Dr Chick.

"The Clinical Futures programme is based on the concept of providing care closer to home, with the Grange treating the sickest patients.

"But if you do need to come here, you will come to a state-of-the-art hospital that provides high-end treatment and sustainable, consultant-led care."