IT is a project first discussed in public 17 years ago, and which on more than one occasion appeared close to being ditched.

But in mid-November, ahead of potentially the most challenging of winters for the NHS in Wales, the Grange University Hospital will take in its first patients.

Gwent's flagship specialist and critical care centre has survived scepticism over its location - at Llanfrechfa, near Cwmbran - the economic downturn and recessions of the late 2000s, multiple project and value-for-money reviews, and crucially, the test of time.

South Wales Argus:

Grange University Hospital

For the fundamental principles behind the hospital and the wider Clinical Futures healthcare modernisation programme in Gwent still apply and are, if anything, more pertinent now than they were back in 2003.

That is when the South Wales Argus first reported the vision for a modernised approach to healthcare across Gwent, in which most care would be delivered closer to people's homes, with a network of local hospitals providing routine diagnostic and treatment services, around a single specialist and critical care centre for treating the area's sickest patients.

Separating emergency and routine treatments is intended to help reduce the push and pull of demand for hospital beds that leads to backlogs and cancellations.

And while there remains more to do to bring more care closer to people's homes and thus reduce the reliance on hospital care, investment in community care and the development of health and wellbeing centres - like that at Brynmawr, and those being planned for areas such as Tredegar and the east of Newport - enable a range of tests and other services to be provided without a trip to hospital.

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An issue that has become ever more pressing as the years have passed is sustaining key services - paediatrics, obstetrics, neonatal, even A&E, to name but four - on more than one hospital site.

Recruiting to key medical posts, and in turn filling staffing rotas to enable such services to be provided at both the Royal Gwent and Nevill Hall Hospitals, without compromising quality of care, has become increasingly difficult.

The Grange University Hospital will, from mid-November centralise the likes of A&E, paediatric inpatients, neonatal intensive care, emergency surgery, complex surgery - for instance for patients who have more than one serious condition in addition to that which requires immediate intervention - and hyper acute stroke care.

But 17 years in the planning and delivery? It seems like an awfully long time in which to bring a hospital, even a big one like the Grange, into being - but the road has been a rocky one.

In that time, much progress has been made on other aspects of Clinical Futures. New hospitals have been built - Ysbyty Ystrad Fawr at Ystrad Mynach and Ysbyty Aneurin Bevan at Ebbw Vale - which are a key part of the network of local general hospitals envisaged back in the early 2000s, along with the Royal Gwent and Nevill Hall, which will be adapting to new roles when the Grange opens.

But the project that was eventually to become the Grange was of a different magnitude entirely, and one that was to run head-on into grim economic reality.

Concerns about the proposed location - predominantly the site of the former Llanfrechfa Grange Hospital near Cwmbran - included access, particularly in terms of emergency vehicles and public transport, and the effect on patients and the wider economy of moving major services out of the Royal Gwent.

The public consultation however, which ended in late 2006, garnered significant support based on the wider aims of the Clinical Futures programme.

Detailed planning began, but the economic downturn that hit the UK from 2007, had profound consequences for the NHS in Wales, bringing to a halt the planning of projects such as the Grange, which at the time was referred to as the Specialist and Critical Care Centre (SCCC).

Late in 2008, Edwina Hart - health minister during the earliest and most acute years of downturn and recession - ordered that planning for projects such as the SCCC be suspended while the then Welsh Assembly Government plotted an uncertain course through a new and austere economic landscape.

It was to be more than two years before Ms Hart reaffirmed that the SCCC could go ahead, during which time a range of options, including not proceeding at all, or building it in phases, were explored.

Planning teams were re-engaged, the project resumed, and was subject to much tinkering and reappraisal over several years, in the face of ongoing austerity and budget constraints.

Was it really necessary that upwards of £300 million be spent on a new hospital to serve the people of Gwent? Could such spending be justified? The project reviews kept answering 'yes'.

By 2015, after the concept and plans for the SCCC had been pored over multiple times in Welsh Government offices in Cardiff Bay, many were beginning to lose hope. Doubts crept in over whether it would be built at all and with Assembly elections looming in spring 2016, further delay was inevitable.

South Wales Argus:

The Grange site in spring 2016, several months before it was confirmed that the project would go ahead with £350m of Welsh Government funding

After that election, Vaughan Gething became the latest health minister to have the SCCC project land on his desk. On October 31 2016, he confirmed that yes, it would go ahead, with £350m of Welsh Government money.

In July 2017 sank the first spade into the ground at Llanfrechfa and 20 months later presided over a topping out ceremony.

South Wales Argus:

Six tower cranes at the site in autumn 2018. Picture: www.christinsleyphotography.co.uk

On that occasion, an exposed and windy four stories up in March 2019, he gave a glimpse of the knife-edge nature of the decision-making process regarding what was now to be known as the Grange University Hospital.

The hospital "nearly didn't happen", he said.

“On my appointment, I had serious discussions about whether this project would actually go ahead.

"It was a difficult conversation with (Welsh Government) colleagues about that choice, but ultimately it was the right thing to do - to invest £350m into not only an excellent building, but a new health and care facility to change the way healthcare is delivered in Gwent and across south Wales.”

This week, Mr Gething was back at the Grange, to approve its earlier-than-planned opening, lobbied for by Aneurin Bevan University Health Board after part of the hospital was readied last April, almost a year early, to take hundreds of patients in the event of a surge in demand for beds at the height of the first wave of coronavirus.

Ultimately, those beds were not needed. But the opportunity of getting the hospital finished four months early, ahead of the coming winter, had opened up.

The project, undertaken by contractors Laing O'Rourke and consultants Gleeds, was on schedule, and the acceleration in the spring - with the help of £10m of extra Welsh Government funding - meant completion before the end of the autumn became possible.

South Wales Argus:

Health minister Vaughan Gething at the Grange University Hospital this week, with (left) Ann Lloyd, who chairs the board of Aneurin Bevan University Health Board, and (right) Laing O'Rourke project director Mike Lewis

Confirming that mid-November opening this week, Mr Gething alluded to the hospital's long gestation, to the hopes, fears and scepticism that have accompanied it over the years, and to the reality of its impending completion.

"This hospital will be open and available in mid-November for people across Gwent," he said.

"Once people come here to be treated I think they will recognise that this is a good place to receive care.

"This is good news for NHS Wales, Aneurin Bevan University Health Board, and the people it serves.

"It is all about dignity, and quality of care, and improving outcomes.

"I hope that all those people who campaigned for it and doubted it would ever happen, will see that this is really good news."