CHANGE is the only way for the health service to survive, says the health boss for west and north Wiltshire.

Local services must be examined closely according to Carol Clarke, the joint chief executive of West Wiltshire and Kennet and North Wiltshire Primary Care Trusts. Mrs Clarke also said when discussing community hospitals, people must distinguish between what they want and what is needed.

But defenders of the smaller hospitals have hit back, saying they are the pillars of the community.

"We are going through the Pathways For Change consultation that will determine services that people want and need locally," said Mrs Clarke. "In terms of the activities in community hospitals it is a tiny percentage of the total health care provided.

"People clearly like local services, and there is a warmth and nice feeling from knowing the building just down the road

"In general, increasingly more care can be provided at home not in hospitals."

"But we also need to look at what services we might want locally that are not currently delivered that way."

In Melksham, services were cut after the hospital failed to secure GP contract cover for the inpatients ward.

Fears for the long-term future of the hospital grew when it was announced 24 beds were being axed.

"The new GP contracts came in over a year ago putting considerable pressure on general practice," said Mrs Clarke. "Sometimes people may want things they don't need. With the Pathways For Change there are going to be five assemblies over the coming months with the first one held last week.

"It is a chance for all members of the community to shape health care.

"All people have very strong views on preserving their local facilities and you can see this by the marches in Warminster and Melksham.

"I respect that is their strongly held belief but that doesn't mean I can't have a view that we should be challenging all our community to provide better health care over the next 10 to 15 years.

"We have to be brave enough to move forward and not simply dig our heels in and refuse to change."

West Wiltshire MP Dr Andrew Murrison is a fierce defender of the cottage hospitals. He said: "There is a strong economic argument for boosting services in community hospitals that I don't think has been made strongly up to this point. There is an even stronger case for having services locally in terms of convenience and benefit to patients."

A public meeting for people in Melksham to quiz Mrs Clarke was due to be held in the Assembly Hall last night. A protest march through the town is also planned on June 18.