WILTSHIRE residents will have to be prepared to lose their cottage hospitals if health services appropriate to the 21st century can be secured for the county.

That was the message at the launch this week of Pathways for Change, a far-reaching consultation process which will involve health professionals, local councils and members of hospital leagues of friends.

Carol Clarke, the chief executive of both Kennet and North Wiltshire and West Wiltshire primary care trusts, said information gleaned from previous consultations will not go to waste but the entire structure of services in the local area had to be examined very closely.

She told a press conference at Chippenham Hospital last Thursday: "Change is inevitable. The health service is very old-fashioned in many ways. We want to talk to our communities about the pressures we are facing and their needs as far as health services are concerned.

"We will be considering the needs of the community rather than wants, which are not necessarily the same thing. We will be assessing priorities and coming up with some bold proposals to create a flexible service infrastructure."

Pathways for Change calls for five "engagement assemblies" at which the PCTs will meet with stakeholders throughout the community.

Invitations have gone out to nearly 200 representatives of local groups to attend the first assembly today.

The process will be overshadowed by the deficit under which both PCTs are operating. Currently this is running at about £15 million for both and Mrs Clarke said that the process will be looking at ways of running health services in the area more cost effectively.

The stress will be on providing services, particularly to keep elderly people living independently in their own homes and treating them for their illnesses at home. This will involve setting up teams of health professionals to provide 24-hour care to people in their own homes, rather than maintaining expensive hospital buildings.

Dr Simon Burrell, the Corsham-based GP who is chairman of the trust's professional and executive committee, said: "The NHS has been built up in a piecemeal fashion over the years and hasn't got much cohesion. It should be about what might happen and stopping it from happening. We must start again from the very beginning."

Mrs Clarke said: "This is not about cuts. What people have to realise is that there are choices that need to be made here. They have to understand that if you want to put money into one service, it will mean that another service doesn't get the investment it might need."

The five assemblies will take place between now and February. The findings will then be collated and a plan of services devised, for consideration by the joint board of the two PCTs and use as a basis for future service provision.