A public consultation is being launched which could see some west Wales hospitals losing services, including an option for Withybush patients needing specialist critical care being transferred to Glangwili.

Another option, in Ceredigion, includes the loss of Bronglais’s stroke service, becoming a ‘treat and transfer’ hospital, with patients transferred to to other hospitals in the board area, including Withybush for their inpatient stroke care.

Hywel Dda University Health Board’s Clinical Services Plan focuses on nine healthcare services that are “fragile and in need of change,” it has said.

The services, and potential changes at the four main hospitals of Haverfordwest’s Withybush, Carmarthen’s Glangwili, Llanelli’s Prince Philip and Aberystwyth’s Bronglais, included are critical care, emergency general surgery, stroke, endoscopy, radiology, dermatology, ophthalmology, orthopaedics, and urology.

There are no changes to how people access emergency care (A&E) or minor injury care as part of the consultation, with an ongoing separate consultation on minor injury care at Prince Philip.

These nine clinical services were selected because of risks to them being able to continue to offer safe, high-quality services, or care in a timely manner, the board has previously said.

At the May 29 meeting of the board, members agreed to back the launching of a public consultation, running to August 31, into the proposed changes, with many different options in each of the nine services across the area, with some hospitals gaining or losing services, along with community site options in some cases.

In the case of critical care, there are three options.

  • Intensive care units kept at Bronglais and Glangwili. An enhanced care unit would be provided at Withybush and Prince Philip. Another enhanced care unit would also be developed at Glangwili, so the intensive care unit at Glangwili can focus on the sickest patients.

Patients at Prince Philip or Withybush needing specialist critical care would be transferred to Glangwili.

  • Intensive care units would be kept at Bronglais, Glangwili and Withybush. Prince Philip would have an enhanced care unit. Patients needing specialist critical care would be stabilised at Prince Philip and transferred to Glangwili intensive care unit.
  • Intensive care units kept at all sites.

In the case of emergency general surgery, there are two options.

Currently, full emergency general surgery services, including surgical operations, for adults are provided at Glangwili, Bronglais and Withybush. Patients from Prince Philip are taken to Glangwili.

  • Emergency general surgery consultant surgeons would be based at Bronglais and Glangwili, providing full emergency general surgery services including surgical operations. Patients at Withybush needing surgery would be transported to Glangwili for their operation, before returning to Withybush when fit to do so to recover.
  • Emergency general surgery consultant surgeons would be based at Bronglais, and at either Glangwili or Withybush on alternate weeks to provide surgical operations.

There is an additional need with this option for surgical cover to remain at Glangwili for children and young people (paediatrics) on weeks when the service is operating in Withybush.

There are two options proposed for stroke services, currently operated at all four main hospitals, including Prince Philip and Withybush having stroke units, with specialist cover 12-hours a day, meaning stroke patients from ‘treat and transfer’ hospitals at Bronglais and Glangwili would be transferred to Prince Philip or Withybush for their inpatient stroke care.

For endoscopy, operating from from Bronglais, Glangwili, Prince Philip and Withybush, there are three options, including Bronglais no longer offering urology, as it does now, and Glangwili no longer offering respiratory and urology.

Bronglais Hospital, Aberystwyth
Bronglais Hospital, Aberystwyth (File image)

For radiology, there are four options.

Planned diagnostic radiology and planned day case interventional radiology (both Monday-Friday, daytime) is provided from Bronglais, Prince Philip and Withybush.

One option includes planned diagnostic radiology provided from a new and dedicated diagnostic hub (site to be confirmed), in a community setting, which is not part of the other options.

This new hub and the extended working hours for planned diagnostic radiology would mean Prince Philip and Withybush could provide a dedicated cancer focus.

For dermatology, there are four options.

Since the Covid-19 pandemic, dermatology services including outpatient appointments and minor operations have mainly been provided at Prince Philip.

For ophthalmology, there are three options, including a community setting (site not yet confirmed) in Pembrokeshire.

For orthopaedics, there are four options; and for urology, currently provided at all four main hospital sites, there is one option, to bring overnight patients (inpatients) together at Prince Philip Hospital. Outpatients, day cases and other diagnostics would remain at Bronglais and Withybush. Glangwili would only look after emergency cases that come through the emergency department.

At the May 29, meeting, Medical Director Mr Mark Henwood said: “No decisions have been made on the options presented, and there are currently no preferred solutions. The changes we are looking to make are to ensure we have safe, high-quality services and affordable healthcare in the future, and have at their heart the best interests of the people of west Wales and their patient experience.”

“We ask that you review the consultation documents and share your views on which options you believe are best able to address service fragilities, improve standards, or reduce waiting times.”

“We want to listen to your concerns or potential impacts you think options may have and your views on the future role of our hospitals. We also welcome any alternative options or ideas you may have.”

Following consultation, the proposals will be further discussed at a future health board meeting, expected to be November of this year.

Public drop-in events are being held throughout the region over June and July.

The full consultation details may be viewed online at: https://hduhb.nhs.wales/news/press-releases/hywel-dda-uhb-launches-clinical-services-plan-consultation/