Emergency surgery centralised as Withybush role shifts toward planned care

MAJOR changes to hospital services across west Wales have been approved following an extraordinary meeting of Hywel Dda University Health Board on Thursday (Feb 19).

Board members agreed the next steps in the organisation’s Clinical Services Plan, covering nine services identified as under pressure or “fragile”, including emergency general surgery, critical care, stroke and orthopaedics.

The decisions will see some specialist services concentrated on fewer hospital sites, alongside plans to expand planned care at Prince Philip Hospital in Llanelli and Withybush Hospital in Haverfordwest.

Health chiefs stressed that no immediate changes would take place, with implementation expected to happen gradually over several years.

Consultation and decision process

During summer 2025, the Health Board carried out a major public consultation involving more than 4,000 questionnaire responses and engagement events attended by over 4,000 people.

An independent report produced by Opinion Research Services summarised the feedback, while board members also considered workforce pressures, clinical standards, estate issues and financial factors.

Twenty-two alternative proposals submitted by the public were formally assessed against criteria including sustainability, accessibility and deliverability.

Emergency surgery changes

Under the plans, emergency general surgery operations will be concentrated at Glangwili Hospital in Carmarthen and Bronglais Hospital in Aberystwyth.

Patients from Pembrokeshire requiring surgery will be transferred to Glangwili when operative treatment is needed.

However, emergency departments will continue operating as normal at all four hospitals.

Other service changes

Across the region, the approved direction includes:

• Intensive care units remaining at Bronglais, Glangwili and Withybush, with Prince Philip Hospital providing enhanced care for less critically ill patients.
• Dermatology services primarily based at Prince Philip Hospital, supported by community clinics and telemedicine.
• Endoscopy procedures brought together at Prince Philip while retaining bowel screening across sites.
• Ophthalmology services concentrated mainly at Glangwili with community provision elsewhere.
• Orthopaedic surgery expanding at Withybush for less complex procedures.
• Radiology retaining emergency imaging at all hospitals with new diagnostic hubs planned.
• Urology inpatient care centralised at Prince Philip Hospital.

Stroke services remain under review, with further public engagement planned before final decisions.

Future role of hospitals

The Board confirmed the intended future roles of the four main hospitals:

• Bronglais Hospital — broad range of services.
• Glangwili Hospital — increasing focus on acute and emergency care.
• Prince Philip Hospital — expanding planned care role.
• Withybush Hospital — increased planned care activity while continuing initial emergency access.

Health leaders emphasised there would be no change to how patients access emergency departments or minor injury units.

Board leaders respond

Health Board Chair Dr Neil Wooding said the changes were necessary to secure services for the future.

“Our ambition is for people to live healthier lives for longer by supporting people to keep well and preventing ill health,” he said.

“These decisions are not easy, but as a Board we have a duty to ensure that our services provide the best outcomes for our patients and meet the highest standards.”

Lee Davies, Executive Director of Strategy and Planning, said most services now had a clear direction.

“Our priority is always to deliver the highest standards of care for our patients across Hywel Dda and neighbouring communities,” he said.

Next steps

Detailed implementation plans will now be developed, with further engagement expected in areas where decisions are not yet finalised, particularly stroke services.

Patients are being advised to continue attending appointments as normal while the changes are planned.

More information, including board papers and meeting recordings, is available via the Health Board website.

Executive Director says emergency surgery transfer is about quality — not loss

THE EXECUTIVE DIRECTOR of Strategy and Planning at Hywel Dda University Health Board has defended the decision to transfer certain emergency surgery operations from Withybush Hospital, saying the changes are designed to strengthen services rather than remove them.

Lee Davies told The Herald the “single biggest change” people in west Wales will notice is increased resilience across hospital services.

“The most significant change will be increased resilience and sustainability across services in West Wales,” he said.

“We are strengthening the way services are delivered so that they are less vulnerable to staffing pressures and more consistently available.”

Why now?

Mr Davies said the decision was driven by concerns that some services had become overly dependent on small numbers of clinicians.

“Wales covers a large geographical area, and currently many services are delivered across multiple sites,” he said.

“That has meant that clinical teams are often spread thinly, with some services heavily dependent on a small number of individuals.

“As a result, those services can become vulnerable if staffing circumstances change.”

He added that in certain areas, performance was not matching standards seen in larger UK centres.

“These changes are necessary to strengthen our services, improve sustainability, and ensure we consistently meet high standards of care.”

Emergency surgery at Withybush

Mr Davies confirmed that patients requiring certain general surgery operations will now be transferred to Glangwili Hospital.

However, he rejected suggestions that this amounted to the removal of all emergency surgical care from Pembrokeshire.

“This does not mean that all emergency surgery activity will cease at Withybush Hospital,” he said.

“A small number of patients who require operative procedures will be transferred to Glangwili. Where appropriate, patients will be transferred back to Withybush at the earliest opportunity.”

He acknowledged that some residents may perceive the change as a loss.

“We recognise that some people may see this as a loss,” he said.

“Rather than reacting to staffing pressures in an unplanned way, we are proactively designing a more sustainable and stable model. We believe this approach will provide safer, higher-quality care for the people of Pembrokeshire.”

Reassurance over local hospitals

Asked whether any hospital would lose services under the wider Clinical Services Plan, Mr Davies said no community would lose access.

“There will be changes to how services are provided across West Wales,” he said.

“However, no community will lose access to services. In some cases, services may be delivered in a different location or in a different way.”

He added that all four main hospital sites would continue to play a “vital and important role”.

Monitoring outcomes

Mr Davies said the board had established baseline quality and safety data ahead of the changes and would closely monitor performance.

“We have defined outcome measures and performance expectations,” he said.

“As we move into the improvement phase, we will evaluate whether the changes are delivering anticipated improvements in quality, safety and patient experience.”

How Pembrokeshire’s main hospital has changed over more than a decade

WITHYBUSH HOSPITAL reopened in 1979 as Pembrokeshire’s flagship district general hospital, providing consultant-led maternity, a Special Care Baby Unit, 24-hour inpatient children’s services, emergency general surgery and comprehensive emergency care.

For decades it functioned as the county’s main acute hospital.

Today it still delivers vital care — but its role has changed significantly.

Over the past 12 years, a series of decisions have altered the scope of services, with campaigners describing the process as the gradual “salami-slicing” of the hospital.

Health leaders say changes have been driven by patient safety concerns, national workforce shortages and the need to deliver sustainable specialist services.

Critics argue the cumulative effect has been a steady centralisation of care away from Pembrokeshire, particularly towards Glangwili Hospital in Carmarthen.

The latest decision to remove emergency general surgery has brought that long-running debate sharply back into focus.

Timeline: How services have changed

2014 — Consultant-led maternity and SCBU withdrawn

One of the most controversial changes came when consultant-led obstetric services and the Special Care Baby Unit were removed.

They were replaced with a midwife-led unit for low-risk births only.

High-risk pregnancies, complex deliveries and babies needing specialist care were transferred to Carmarthen.

The decision triggered some of the largest healthcare protests ever seen in Pembrokeshire, with marches, public meetings and petitions to the Welsh Government.

Although later evaluations reported high satisfaction among women using the midwife-led unit, concerns about travel distances and emergency risks persisted.

For many residents, this moment marked the beginning of a wider shift in the hospital’s role.

2014 — Inpatient children’s ward closed

The same year saw the removal of 24-hour inpatient paediatric services.

A Paediatric Ambulatory Care Unit was introduced instead, initially operating from 10:00am to 10:00pm, providing assessment and short-stay treatment but no overnight admissions.

Children requiring inpatient care were transferred to Glangwili Hospital.

Campaigners warned the paired maternity and paediatric changes were the “thin end of the wedge.”

2016 — Paediatric unit hours reduced

Opening hours for paediatric ambulatory services were reduced further to approximately 10:00am to 6:00pm because of staffing shortages.

The change was described as temporary at the time.

Staffing improvements announced in 2025 allowed the service to expand again, but full inpatient paediatric provision has not returned.

Late 2010s — Plans raise fears of hospital downgrading

The Hywel Dda University Health Board launched its “Transforming Clinical Services” programme, exploring major changes across west Wales hospitals.

Some options would have reduced Withybush to a community-style hospital with fewer acute functions, while concentrating specialist care elsewhere.

Plans also included a proposed new regional “border hospital” serving Pembrokeshire and south Ceredigion, potentially near Narberth or St Clears.

Public opposition was intense.

Hundreds attended protests in Haverfordwest and across the county, while Senedd petitions attracted significant support.

The proposed new hospital remains years away, with funding and timelines uncertain.

2019–2023 — Workforce pressures and RAAC crisis

Recruitment difficulties persisted across multiple specialties, reflecting wider NHS workforce shortages.

The discovery of reinforced autoclaved aerated concrete (RAAC) created major operational disruption, with more than 100 beds affected at various stages.

Ward closures, temporary relocations and ongoing remediation works continued into 2025 and 2026.

Healthcare Inspectorate Wales inspections also highlighted pressures on emergency department capacity, patient flow and governance during winter demand surges.

2025 — Consultation on nine “fragile” services

The Health Board consulted communities on potential changes affecting nine services including emergency general surgery, stroke care and critical care.

Officials described the services as fragile and at risk of becoming unsustainable in their existing form.

More than 190 alternative ideas were submitted by the public during the consultation process.

February 2026 — Emergency general surgery removed

Following a two-day board meeting on Feb 18 and 19, emergency general surgery operations were removed from Withybush.

Patients requiring emergency surgery will now be transferred to other hospitals, mainly Glangwili.

Same-day emergency care services are expected to be strengthened locally.

Board members were told the decision was about improving quality and safety.

Health Board Chief Executive Phil Kloer said proposals were aimed at improving care for patients, while clinicians raised concerns about alternative models such as alternating emergency surgery between hospitals on different weeks.

Political backlash and reactions

Local Senedd Member Paul Davies said he was “appalled” by the decision.

He said: “I’m appalled that Hywel Dda University Health Board has voted to remove general emergency services from Withybush Hospital — but I’m not surprised.”

Plaid Cymru representatives also expressed disappointment, with calls for the decision to be reconsidered.

Earlier in January 2026, Mr Davies and fellow Senedd Member Samuel Kurtz had warned that maintaining emergency services at Withybush was a “red line.”

Mr Davies has said he will now seek Welsh Government intervention.

The “salami-slicing” argument

Campaign group Save Withybush Action Team (SWAT) has used the phrase “salami slicing” for more than a decade.

The term reflects the belief that no single decision closes the hospital — but each change reduces its capability, making further changes easier.

Campaigners have previously warned this could create a cycle where:

• services reduce
• recruitment becomes harder
• fragility increases
• further centralisation follows

Health Board leaders reject the accusation, saying decisions are based on clinical evidence, workforce realities and patient safety.

Rural realities driving concern

Pembrokeshire’s geography plays a major role in public anxiety.

The county is large and rural, with limited public transport and long travel distances to alternative hospitals.

Campaigners argue centralisation risks:

• longer ambulance journeys
• delays in time-critical conditions
• additional hardship for elderly or low-income residents
• challenges during winter weather
• increased pressure during tourist season population surges

Critics also warn that removing services can undermine the long-term sustainability of the emergency department, even where no formal A&E closure is proposed.

What services remain at Withybush

Despite the changes, the hospital continues to provide major local healthcare services including:

• a 24-hour emergency department
• same-day emergency care
• a midwife-led maternity unit
• outpatient clinics and diagnostics
• some planned and elective treatments

However, it no longer operates as the comprehensive district general hospital it once was.

A debate far from over

For many residents, Withybush is more than a hospital.

It represents fairness, access and confidence that rural communities receive equal healthcare provision.

The tension between clinical centralisation and local provision remains one of the most politically sensitive issues in west Wales.

The latest decision is unlikely to be the final chapter.