Patient care and staff safety will be at risk unless Oxfordshire's cottage hospitals are upgraded as a matter of urgency, according to an independent consultant.

A review of the county's nine community units said some may be forced to close because of staff shortages. The buildings were old, and not designed for modern healthcare.

Oxfordshire Community Health Council agreed with the report, but warned that the county's ageing population meant the hospitals would face increasing demand for their services in the future.

Oxfordshire's primary care trusts commissioned Liz Ollier to look at services in Witney, Thame, Wallingford, Wantage, Chipping Norton, Abingdon, Bicester, Henley and Didcot. She said problems included inadequate patient privacy, access difficulties and a lack of space.

She said: "As well as compromising patients' dignity and privacy, these problems also present a health-and-safety risk to staff."

The report said: "The recruitment shortage in the nursing workforce is a major factor and some services may have to close because they cannot provide safe staffing levels.

"While nothing, at this point, has been decided, doing nothing compromises patient care and staff safety, and is not an option.

"The future direction of community hospitals needs to be discussed as a matter of urgency by health, social care and community organisations, by staff and by the public."

Community hospitals are looked after by Oxfordshire's five primary care trusts and staffed by their own nurses and GPs.

They are used for rehabilitation and respite of the elderly and infirm, day care, and specialist clinics, as well as providing care for patients discharged from major hospitals.

At the moment, staff shortages mean six out of a total 280 beds are closed across the nine sites.

Ms Ollier said whatever a patient's needs, most of the community hospitals had the same facilities. For example, those having rehabilitation treatment were not separated from the terminally ill.

PCT managers are now setting up a county-wide project team to look at ways to improve community hospital services.

Spokesman Ms Helen Peggs said they were still in the early stages and it was not known how long it would take before the hospitals were upgraded or how much it would cost.

She said: "There's a lot of work to be done to see how to modernise services and no conclusions have been made yet.

"What the review says is that some community hospital buildings are quite old and in need of constant maintenance. We can't just sit back and let things go by. The buildings are just not good enough for another decade."

Oxfordshire Community Health Council chief officer Mrs Linda Waxen said members had battled to save community hospitals before Burford and Watlington were closed in 1999, but did realise that some of the smaller units could not offer very specialist care.

She said: "In Oxfordshire's stroke strategy for example, the latest discussion is that it's to be developed across the county, but it can't be done in all the community hospitals, so what happens to the others?

"It's a bullet that's got to be bitten. We understand the dilemma they are facing, but with the aging population it would be very silly to pull the plug on any services because they could be in demand in the future."