Withybush to provide initial treatment before specialist care elsewhere

PEMBROKESHIRE patients who suffer a stroke are set to be transferred out of county for specialist treatment under major changes approved this week by Hywel Dda University Health Board.

Under the new model, patients suspected of having a stroke will continue to receive initial assessment and emergency treatment at Withybush Hospital.

However, those requiring specialist stroke care will then be transferred to Glangwili Hospital in Carmarthen, which is expected to become the main specialist stroke centre for the region.

Health leaders say concentrating specialist services in one location will improve outcomes by ensuring patients are treated by dedicated teams with greater expertise and availability.

Concerns about travel times

The changes are likely to raise concerns in Pembrokeshire, where travel distances to Carmarthen can be significant and ambulance journeys lengthy, particularly from rural communities.

Stroke treatment is highly time-critical, with outcomes often depending on how quickly specialist care can be delivered.

Campaigners have previously warned that longer transfer times could increase risks for patients in remote parts of west Wales.

Local care still provided

Health officials stress that Withybush Hospital will continue to play an important role in stroke care.

Patients will still receive emergency assessment, stabilisation and initial treatment locally before transfer if specialist intervention is required.

Where appropriate, patients may later be transferred back closer to home for recovery.

Regional plans still developing

As part of the wider changes across west Wales, proposals to develop enhanced stroke rehabilitation services at Bronglais Hospital in Aberystwyth remain subject to further risk assessment and community consultation.

No final decision has yet been confirmed.

Changing role of Withybush

The stroke changes represent another shift in how services are delivered at Withybush Hospital, with specialist treatment increasingly concentrated at larger centres elsewhere in the region.

The hospital will continue to provide a 24-hour emergency department, diagnostics and other core services, but the way patients access specialist care is evolving.

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.”