COMMUNITY hospital services are to undergo sweeping changes with more people going to care homes or being treated at home.

The Kennet and North Wiltshire Primary Care Trust, which runs the community hospitals in Devizes, Malmesbury, Chippenham and Savernake, in Marlborough, has issued its proposals in a consultation document to cut a £10million debt.

The trust insists that, as well as saving money, the proposed changes will modernise services.

But while Chippenham and Savernake hospitals will see improvements, Devizes and Malmesbury hospitals will close altogether and be replaced with nursing homes and health centres. Proposals for the maternity units in Devizes and Malmesbury will not be published until July.

Out-patient services including physiotherapy, child health checks, mental health, blood testing and chiropody will be provided at a new unit at Green Lane, Devizes, and in Malmesbury, but X-rays will no longer be carried out in the two towns. Instead, people will have to travel to Savernake or Chippenham hospitals.

It is also proposed that the minor injuries units at Devizes and Malmesbury hospitals should be closed and the service provided by nurse practitioners in GP surgeries during normal opening hours.

A number of services are being considered for Devizes. These include 16 hospital beds and a diagnostic and day surgery centre at Green Lane run by a consultant. The trust however, has made it clear there are no guarantees that this will be provided in the near future.

Simon Burrell, a Corsham GP who is the chairman of the trust's professional executive committee, said: "Our local services don't necessarily match the modern health care agenda. These proposals are about freeing up the system.

"The community hospitals are not there to provide a back-up when the carers are having problems. I don't think there are any other areas in the country with so many community hospitals. We are proposing a sophisticated system to get people better quickly.

"There is evidence if patients go home after being treated at an acute hospital rather than going to a community hospital then their outcomes are better.

"If you stay too long in a highly supportive environment you get out of the habit of looking after yourself and lose confidence.

"If people get home quickly more people stay at home."

Trust chief executive Barbara Smith said: "Our proposals are about disinvesting money in bricks and mortar and spending more money on services. They are about sharing the costs of bricks and mortar with other providers to release funding which we can put into intermediate and community care."