Two west Wales hospitals will be downgraded or “repurposed” as part of Hywel Dda Health Board’s controversial shake up of services.

Following consultation this summer there were ten recommendations approved by the health board at an extraordinary ‘Transforming Clinical Services’ meeting at Carmarthenshire County Council’s offices today (Wednesday, September 26).

The key recommendations include the plan to build a new urgent and planned care hospital somewhere between Narberth and St Clears and retained acute hospital services at Bronglais in Aberystwyth.

Both Withybush and Glangwili General Hospitals will be “repurposed” to offer a range of services to support as social model for health and well-being, designed with local people to meet their needs.

In a change to the proposed option consulted on acute medicine services will also be retained at Prince Philip Hospital in Llanelli.

The health board approved the development and implementation of a community model, based on an integrated social model for health and well-being.

“This will include clearly describing what is meant by integrated networks, moving away from the term “Hub”; enabling help and support to be accessed in a variety of ways including both face to face and virtually and commit to concentrating on early co-design of the model in Pembrokeshire, in response to the strength of feeling expressed throughout the consultation in terms of a loss of services, with particular focus on an enhanced 24/7 community response,” it states.

The second recommendation approved was the development of a plan for the existing Community Hospitals, working with local communities. This plan will be focussed on the provision of ambulatory care including out-patient services, diagnostics, treatment, observation, rehabilitation and end of life care.

This includes developing a “long term plan that enables the delivery of acute medicine over time to be tested and challenged, and to be responsive to demand and patient flows associated with the proposed changes.”

As well as developing a “transition plan to transfer emergency and urgent services from existing General Hospitals in a safe and sustainable phased way, dependent on the development and impact of the model and the new Urgent and Planned Care Hospital.”

Work with neighbouring health boards will be key to developing a health strategy, particularly ABMU’s clinical strategy to maximise “opportunities for effective regional pathways.”

A range of options designed to “ensure consultant-led obstetrics, midwifery led care, acute paediatrics and neonatal care are maintained across Hywel Dda” will be looked at and there is a guarantee of complete alignment with the requirements of the Transforming Mental Health Programme.

The start of a business case for a new planned and urgent care hospital is given the go-ahead as well as consideration of location options via feasibility study and “options appraisal to robustly consider all potential impacts.”

A detailed plan addressing significant concerns about access, travel, transport and infrastructure will be developed along with a plan to maximise the use of technology.

The case for change focusses on the need to ensure “fragile” services do not collapse due to rising demand and staffing issues.

Jeremy Williams, clinical director for unscheduled care, said increasing waiting times in both emergency and planned care would be overcome by the new model as well as reducing the need for cancellations.

Independent member David Powell wanted assurance that the changes would address the current fragility issues, highlighting a low-level of public belief that it would.

Financial issues also need to be overcome with Elaine Lorton, county director for Pembrokeshire, stating that Hywel Dda is £0.9million in excess of its planned deficit in month five of the year.Hywel Dda’s 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. “We’ve heard the concern people have with current healthcare provision and our ability to deliver this sea-change in the years to come but our clinicians have led this work and we believe what has been put before us today 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.”Chair Bernardine Rees added: “We are really grateful to everyone who got involved in our consultation as it has given us really rich feedback. Our ambition is to continue that conversation and input so that we can grow services in our seven localities, using schemes we have already delivered, such as the front of house project at Prince Philip Hospital and Tenby walk-in, as the basis of what can be achieved.”The next step will be for clinicians and staff to work with the public and other organisations to bring the additional detail together into a draft Health Strategy to put before public Health Board at the end of November.Medical Director and Director of Clinical Strategy Dr Philip Kloer said: “We’re aware that some people, particularly those who live furthest from the new hospital zone between Narberth and St Clears may be anxious about these changes. They will not happen overnight and we are committed to working with those communities and our partners to demonstrate and test what additional provision can be made, particularly for time-sensitive emergency conditions.“For example we are working with partners to build the case for the Emergency Medical Retrieval Team (doctors who are brought to the scene to treat and then transfer) and CHANTS (the Neonatal Retrieval Team) to be a 24-hour service, and also investigating the potential to place advanced paramedics in communities so they are available solely to that community.“Another important factor in providing life-saving treatment is getting people quickly to the definitive hospital which will provide their care. At the moment, people in our coastal areas of Pembrokeshire have to travel to Glangwili for some treatment, which in the future, we will be able to offer at a more equitable location, for the south of Hywel Dda, in the new hospital zone.”Local Assembly Member Paul Davies has expressed his anger at the recent announcement that Withybush hospital will be ‘repurposed’ and lose its status as a round-the-clock general hospital. Mr Davies is calling on the Welsh Government to urgently intervene in the matter and reverse the health board’s catastrophic decision. “I’m extremely angry and disappointed that following an extensive public consultation, Hywel Dda University Health Board has simply ignored the views of the people of Pembrokeshire,” he said.“It is unacceptable that Withybush hospital will be downgraded and that patients will have to travel further for essential treatments and services.“This is a very dark day for the people of Pembrokeshire, who have seen health services constantly centralised away in recent years. “The Welsh Government has a duty to ensure all parts of Wales have access to essential health services and so it must take a stand against Hywel Dda University Health Board and act now – before it’s too late,” he added.The plans to change health services in Pembrokeshire in the face of strong local opposition have been called a “kick in the teeth” by Stephen Crabb MP.Responding to the approval of plans that will see Withybsuh Hospital stripped of its A&Ein the future, Mr. Crabb said: “Today’s announcement makes a mockery of consulting the public, but it is hardly surprising. “It is another kick in the teeth for the people of Pembrokeshire. We have been through these consultations before and at every turn the views of local people get ignored. The biggest response to the West Wales consultation came from here in Pembrokeshire precisely because it is the area that loses out the most from all the options the Health Board put forward.“The decision to keep a full hospital at Llanelli looks very political. It fits with the big plan that Welsh Government in Cardiff have been pushing for the last ten years which is to reduce and centralise services further east.“If the long-term plan is to build a new hospital then we need some cast iron commitments from Welsh Government over funding and location and a promise not to reduce any more services at Withybush until that new facility is open and functioning.”Plaid Cymru said it was calling on the health secretary to intervene and properly merge health and social services.Representatives called the proposals “disappointing” and a “missed opportunity to genuinely transform health and social care.”Helen Mary Jones, Plaid Cymru AM for Mid and West Wales said: “This decision is the latest in a long line in the never ending saga that is hospital reconfiguration and in particular the persistent proposals to remove essential emergency services from smaller hospitals whilst failing to strengthen primary care and tackle the chronic workforce shortages faced by rural health boards.“It is clear to us that the Health Board’s choice doesn’t address how services will actually be improved in the short to medium term. There is no proposal for better out-of-hours care, no plan for substantial increases in social care services, and no plans for investing in the ambulance services – only the removal of essential services and the hope that maybe, one day, we’ll see a new hospital.“The decision also makes no mention of the transformation that needs to occur in the relationship with local authorities and the third sector for the changes to be realised.”