Prof Edwards' recommendations include an increase in bed capacity, basing a separate unit at St Woolos Hospital in Newport and improving budget management.

He also said waiting list validation - the status of patients waiting for operations - needed to be improved.

I have already put �2.25m into the orthopaedic service in Gwent and clearly there are financial implications in this report Jane Hutt

He told BBC Wales: "For the assembly government they have decided to make some additional investments in capacity.

"Two ideas: one to build new facilities at St Woolos Hospital immediately behind this hospital and secondly in Nevill Hall [in Abergavenny].

"But there is lots that the local community in Gwent can do as well as the assembly, so there has to be a partnership.

"They both have to act together."

Ms Hutt would not be drawn on the issue of extra funding for Gwent.

"I have already put �2.25m into the orthopaedic service in Gwent and clearly there are financial implications in this report.

"This is what I'm going to be considering very carefully."

Plaid Cymru health spokesman Dai Lloyd AM said: "The bed shortage is particularly acute in Gwent and in the Royal Gwent.

Andrew Grant: Gwent needs more facilities

"The hospital has a large hinterland of population and deals with much illness.

"It can't cope with the bed capacity it has."

South Wales East Conservative AM William Graham commented: "It outlines a bleak picture for those currently awaiting treatment.

"A determined attempt to see more outpatients will quickly result in a longer waiting list for surgery."

Andrew Grant from the Royal Gwent Hospital said the waiting times showed the service was "failing the people of Gwent".

"To meet that responsibility, we need more facilities," he added.

The report into Gwent orthopaedic services came out on the same day new figures revealed a rise in patients waiting more than a year for hospital treatment across Wales.

In the latest figures released by the Welsh Assembly Government, those waiting more than 12 months rose by 4.4% to 9,627 and those waiting 18 months by nearly 7%.

Some patients at the Royal Gwent say they have been waiting years for routine surgery.

'Pain'

Stuart Israel, 71, from Newport, has been waiting nearly four years for an operation on a cyst on his arm.

He said: "When I know a lot of people who have got intense pain and have done so for years and still they wait and wait, I feel a bit ashamed to complain about it.

"But on the other hand, I still think that three years and nine months is something that one should complain about."