There is no threat to any of Powys's 10 community hospitals

The aim is to ensure decisions are made closer to the community but there are fears that services will be affected because the project will cost �3m a year more than funds allow.

It is part of the overall reorganisation of health care in Wales which sees the five health authorities replaced by 22 local health boards.

However, the Powys scheme is unique in the UK because it is acting as both supplier and the buyer of health services and if successful could be extended to the rest of Wales.

From Tuesday, Powys Local Health Board (PLHB) will do the work previously done by Powys Health Care NHS Trust, Dyfed Powys Health Authority and Powys Local Health Group.

Patients will not see any difference apart from the sign at the end of the hospital's drive Chris Mann, PLHB chairman

The advantage of this change, according to the chairman of the new board Chris Mann is that only one organisation in Powys will now decide and provide the services needed.

Community hospitals

But the board has inherited a debt of �5m from the organisations it has replaced.

"The debt is something we'll have to manage but services will not be reduced and there is no chance of any of the 10 community hospitals in Powys closing," said Mr Mann.

"Patients will not see any difference apart from the sign at the end of the hospital's drive."

But there will be changes in the way some services are delivered, especially in the way community hospitals link with the six district general hospitals which patients in Powys use but are outside the county.

Health board chairman Chris Mann: 'Rehabilitation services need to improve'

"We want to improve rehabilitation services so that someone recovering from a serious illness can come out of a district general hospital quickly and receive further care at their local community hospital," said Mr Mann.

Montgomeryshire Community Health Council's Chief Officer John Howard believes the �3m year- on-year shortfall in funding will cause problems.

"It may be that there will have to be changes in the way the 10 community hospitals in Powys are run.

"In future they may have to be health centres for the whole of Powys rather than hospitals just for the local community."

Llanidloes War Memorial Hospital is already doing this by being the base for people in Montgomeryshire to get treatment for eye problems, he said.

Maternity services at Machynlleth may be reviewed

"Maternity services at places like Machynlleth will have to be looked at because Machynlleth hospital delivers so few babies we need to ensure it is safe for mothers, babies and midwives to deliver there."

Bryn Williams, Brecknock and Radnor Community Health Council's Chief Officer, said the new scheme would provide a massive challenge.

"The key to health care in rural area is the development of services such as community nursing and occupational therapy so that people can stay at home as much as is practicable.

Judith Coates is health union, Unison's regional officer for Powys and represents 750 members.

"Powys NHS Trust weren't the best employers because it took us seven years to ensure our members were paid on a national scale rather than the health trust's," said Mrs Coates.