Hospital shake-up proposals outlined for south Wales
Specialist health services such as care for sick newborn babies are spread too thinly and should be concentrated at four or five hospitals in south Wales, say NHS chiefs.
They have been drawing up plans to reorganise services in hospitals from Newport to Swansea.
The plans would see sites become specialist centres, with some care transferred from other hospitals.
Changes could be introduced next spring after a public consultation.
Seven hospitals in south Wales currently provide a mix of specialist services which look after the sickest and most seriously injured patients.
Health bosses said this was not sustainable and patients could be at risk.
The shake-up would affect hospitals along the M4 corridor between Newport, Cardiff and Swansea, and those in the valleys.
Obstetric, neonatal, in-patient paediatric and some high-level accident and emergency services would be centralised at four or five sites.
One would be the University Hospital of Wales in Cardiff and another would be in Swansea.
There are plans for a new critical care centre in Llanfrechfa near Cwmbran that would take services from the Royal Gwent in Newport and Nevill Hall in Abergavenny.
A fourth or fifth site will be chosen from the Prince Charles hospital in Merthyr Tydfil, the Princess of Wales in Bridgend and the Royal Glamorgan in Llantrisant. No preferred site has been chosen yet.
Another unit for major trauma cases treating the most serious emergencies will be chosen. Such cases are currently dealt with in Cardiff and Swansea.
Local health board (LHB) medical directors say some services are heavily reliant on locum doctors, and that the Welsh NHS is being affected by UK-wide problems with recruiting doctors.
They also said that the remaining district general hospitals would not be "downgraded" if services were moved.
Abertawe Bro Morgannwg University (ABMU) Health Board medical director Dr Bruce Ferguson said sometimes patients had to be passed to several hospitals before they could see someone who could treat them because a doctor in that speciality was unavailable.
He said: "Everything is saying to us as clinicians that the status quo how we deliver at present isn't an option for the future.
"The present model means they are not sustainable. They are spread too thinly over too many hospital sites."
He insisted the changes were not a cost-cutting exercise, but an attempt to use resources more more wisely.
It follows a consultation exercise with more than 300 front-line clinicians.
The findings were expected to be approved by ABMU, Cwm Taf, Cardiff and Vale, and Aneurin Bevan health boards on Wednesday.
The plans are not at such an advanced stage as those for reorganising the NHS in mid and west Wales and north Wales where the Hywel Dda and Betsi Cadwaladr health boards are holding public meetings on their shake-ups.
A 12-week engagement period will start in south Wales before a consultation on specific service changes starts after Christmas, running until March.
Speaking in the Senedd chamber, Health Minister Lesley Griffiths said: "We have 115 hospitals in Wales for a population of three million people.
"We cannot keep all the hospitals, I don't think. That's why the health boards are going through these proposals at the moment.
"But it is absolutely essential that patients have safe, sustainable services as close to home as possible and that's something that's going to have to be seen."
Plaid Cymru leader Leanne Wood said: "What must be avoided is a turf war between those district general hospitals yet to be considered as sites for these core services."
Conservative health spokesman Darren Millar said: "No-one should be forced to travel further for life-saving treatment - local health services should be easily accessible to those that need them."