New hospital plan in Hywel Dda controversial health shake-up

A new hospital has been proposed as part of a far-reaching shake-up of NHS services in west Wales.

It comes amid fears services are spread too thinly and could collapse because of rising demand and severe staff shortages.

Hywel Dda health board backed plans which will see Withybush, Haverfordwest and Glangwili, Carmarthen lose round-the-clock A&E services.

The new hospital would be built between Narberth and St Clears.

But the proposal has already been called a "kick in the teeth for Pembrokeshire" by one local MP.

The health board backed a recommendation for what was option B in a recent public consultation, but with some add-ons from the original scenarios:

• Withybush and Glangwili in Carmarthen would lose round-the-clock general hospital status and be "repurposed", although they would not be called community hospitals

• Prince Philip in Llanelli would still be a centre for acute medicine.

• A new general hospital would be built somewhere between Narberth and St Clears to provide A&E, specialist, urgent and planned care. Subject to a full business case being made to Welsh Government

• The "strength of feeling" in Pembrokeshire has been recognised and primary care services in the north of the county would be looked at, as well as the idea of paramedics being permanently located in those areas furthest away

• The issue of beds in small hospitals in the Amman Valley and south Pembrokeshire would be re-examined.

Health board chief executive Steve Moore said: "Today is a hugely momentous day as we confirm we will take a new direction to providing much more preventative and community based healthcare to our population."

He said what had been proposed "offers us the best chance to deal with the fragility our NHS faces and to provide the population with safe, effective care that meets their needs."

• Patients anxious over hospital shake-up

Nearly 5,400 people responded to a questionnaire in a recent consultation and there were 77 different meetings, as well as five different petitions signed by nearly 51,000 people.

But while many backed the need for change to meet challenges, there was opposition particularly to the loss of round-the-clock A&E services in two main hospitals.

The final proposals were discussed at a special health board meeting in Carmarthen.

• What are the changes proposed for Hywel Dda and why?

• Financial situation worsens at west Wales health board

• How much pressure is Hywel Dda under?

What could happen to each hospital?

Bronglais, Aberystwyth

Opened in 1966, currently 152 available beds

Unchanged. The hospital will continue to provide services in mid Wales, including A&E and will develop services where appropriate.

Glangwili, West Wales General, Carmarthen

Opened in 1949, currently 399 available beds

It would no longer be a 24/7 general hospital but provide overnight beds, day cases, outpatients and minor injuries. Refurbishing Glangwili - the oldest of the region's main hospitals - to keep it up to standards would cost a lot.

Prince Philip, Llanelli

Opened in 1990, currently 222 available beds

Under the recommended option it would remain a general hospital offering a minor injuries unit and round-the-clock medical services in the other two options.

A protest at the Senedd during the consultation in July

Withybush, Haverfordwest

Opened in 1979, currently 220 available beds

It would be "repurposed" and lose its status as a round-the-clock general hospital.

It would however have non-medical beds, minor injuries and midwife-led maternity units and be able to carry out scans and tests. Tenby would also have a summer minor injuries unit. More care in the community would be developed to mitigate transport issues for older and frailer patients living in west Pembrokeshire.

But this has provoked the greatest local opposition and a 40,000-signature petition. The consultation found many people wanted Withybush to keep its services, pointing to the area's specific travel, industrial and tourism-related risks.

Local Conservative MP Stephen Crabb reacted angrily, saying: "We have been through these consultations before and at every turn the views of local people get ignored."

New hospital between Narbeth and St Clears

This new-build general hospital would provide A&E, urgent and planned care as well. Although depending on where you live there would be some travel implications, the health board said it was hard to maintain staffing levels at two or three different A&E units across the region.

Inevitably there are different opinions over where it should be. But offering a new 24/7 hospital in one place would help recruitment and offer an emergency service at a rough mid-point between Withybush and Glangwili. It would still require a "detailed business case" and funding.

The Cleddau River day unit is a 'one stop shop' for elderly people to keep them out of hospital

The plans also propose a network of 10 community health hubs - including some existing minor injuries units and hospitals.

South Pembrokeshire Hospital in Pembroke Dock is typical of what the health board hopes to do across the region. It includes rehabilitation for patients recovering from strokes and amputations and a day centre.

The Cleddau River day unit within the hospital is jointly run by the health board and Pembrokeshire council and can give elderly patients care and treatment to keep them out of hospital - and also offer them activities and services like nail-care.

Sarah Davies, a nurse and team leader, said: "The point is to stop people going into hospital in the first place - then we wouldn't be looking at long term beds. We monitor their health, do a lot around nutrition, keep people well, chronic disease management - we keep people out of any acute services as far as humanely possible.

"People enjoy coming here, and some have been coming for 10 years. We offer a respite for families. We like fun, we like to laugh - plenty of cake - it gives people a purpose."

One regular Beryl Connor said: "I do some walking - and it's lovely for anyone on their own."

Amman Valley hospital campaigners arrive for the health board meeting in Carmarthen - they are concerned about the potential loss of beds

What are the challenges?

Hywel Dda covers a quarter of Wales and has both urban and rural challenges.

It also has had the biggest budget deficit in NHS Wales last year of almost £70m - made worse by having to cover the gaps left by several hundred staff vacancies each month.

What are the next steps?

This is first major NHS reorganisation to be outlined since an influential panel of experts called for a "revolution" in the way health and social care was delivered in Wales.

A further detailed meeting is scheduled for the end of November. If the local community health council refuses to back the plan then it could be sent to Health Secretary Vaughan Gething for a final decision.

However, Mr Gething warned earlier this year that NHS services in Wales could "collapse" without urgent transformation and called on politicians from all parties to be "grown up" and to not "run away" from difficult choices.

Campaigners may also ultimately try to challenge the health board's plans in the courts - although previous attempts to overturn decisions were unsuccessful.