HOSPITALS could be closed and services moved as part of a major 20-year shake-up of the NHS in Wales.

Patients face difficult decisions about their local health services as the NHS undergoes fundamental change in a bid to meet the needs of Wales, dubbed the sick man of Europe.

But despite setting out a #25m framework for change in response to July's damning Wanless report, Health Minister Jane Hutt has revealed no details about what will change, when and how.

The Welsh Assembly Government's vision for the future of the NHS was yesterday branded a collection of half-measures unlikely to save the health service by opposition politicians.

Concrete targets for change were visibly missing from the 15-page document which was instead peppered with vague but "laudable" mission statements.

Kirsty Williams, the Liberal Democrats' health spokeswoman, said, "I'm saddened and left with the feeling why did we bother and why did Wanless bother to write his report.

"Despite the fact that we have a hard-working, conscientious and caring minister, the reality is we can't face up to the situation we are in.

"There is no hope that things will change."

And Conservative health spokesman Jonathan Morgan said, "The present position is unsustainable - that was the stark warning from the author [Wanless] - which suggests urgent and immediate action needs to be taken.

"But from what I've seen so far, this report does nothing of the sort. There is nothing to suggest, that in the next 20 years, we will see any changes."

The Wanless report, which was published in July, said the current health system is unsustainable and in 20 years time the NHS would not be able to meet current demand, let alone the future health needs of the population, unless it modernised.

"Currently people working in health and social care try hard to keep up with demand but the system in which they operate does not make life easier - it lets them down," the former chief executive of Nat West Bank Derek Wanless said at the time.

The Welsh Assembly Government's response to the report, revealed yesterday, aims to ensure that the people of Wales have access to health and social care services that are "integrated and responsive to their needs; that help to pursue health and independent lifestyles and are of a consistently high quality."

Priority will be given to preventing ill health, optimising service delivery by providing services that are both effective and meet the needs of the population and performance will be drastically improved as part of the Welsh Assembly Government's vision.

And the public will be given a leading role in shaping the future of the NHS.

It is conceivable in the future that specialist services will only be provided in a select few hospitals and others could close as Wales moves away from the traditional hospital-dominated approach to healthcare which has been blamed for excessive numbers of emergency admissions and cancelled operations and rising waiting lists.

"We will be empowering the people to make effective choices about health and wellbeing, helping them to avoid ill health and working with communities to get the healthcare they need," Ms Hutt said.

"People are going to be fearful of these changes if we don't handle it responsibly.

"We can't just move forward as we have done before - we have to change things.

"This cannot be done top-down. This has to be about a clinical framework of reviewing locally, regionally and nationally what we can safely have in Wales."

But the response was criticised for excluding definite targets against which change could be measured, when and where reviews of services would take place and what services could be closed or re-modelled.

Also missing from the document were responses to specific Wanless recommendations, including establishing a single integrated budget for older people's services and placing responsibility on local authorities to pay the NHS the costs of delayed transfers of care.

Dr Dai Lloyd, Plaid Cymru health spokesman, said, "The Wanless report shows a health service in crisis. It proposes several key actions which must be taken immediately to alleviate the pressure.

"Instead of implementing these, the Government has fallen back on its favourite device to deflect blame - empty rhetoric and misleading spin."