Hywel Dda says a dedicated unit would improve patient safety and specialist support, but no final decision has been made

A SPECIALIST facility in Carmarthen has been identified as the preferred future location for adults detained by police while experiencing a mental health crisis in public.

Hywel Dda University Health Board will be asked on Thursday, July 30, to approve public and staff engagement on plans for a dedicated Section 136 Place of Safety unit at Cwm Seren, within the Hafan Derwen mental health site at St David’s Park.

The proposal could see adult provision concentrated at the Carmarthen facility rather than continuing across a number of existing sites within the health board area.

Section 136 of the Mental Health Act gives police officers the power to remove someone from a public place when they appear to be experiencing a serious mental health crisis and take them to a designated place of safety.

The person can then be assessed by mental health professionals and offered appropriate care and support. The health board has a legal responsibility to provide the service.

A review of the existing arrangements found concerns relating to the suitability of some environments and the ability to provide consistent staffing across several locations.

Five potential models were considered during a multi-agency appraisal involving Dyfed-Powys Police, local authorities, West Wales Action for Mental Health and the patient representative body Llais.

The preferred option is a purpose-built Section 136 suite at Cwm Seren.

According to the health board, the Carmarthen facility would provide the safest, most clinically effective and sustainable model of care.

It says the unit would offer immediate access to specialist mental health staff, improve the management of people considered to be at acute risk and provide better access to physical healthcare when required.

However, concentrating the service in Carmarthen could also raise questions about travelling distances for police, patients and families from Pembrokeshire, Ceredigion and more distant parts of Carmarthenshire.

The health board says those potential effects, together with measures that could reduce them, would form part of the proposed engagement process.

Andrew Carruthers, Chief Operating Officer at Hywel Dda University Health Board, said: “People who are detained under Section 136 are often experiencing some of the most difficult moments of their lives, and it is essential that we provide a safe, supportive environment where they can receive timely assessment.

“The work undertaken with our partners has carefully considered a range of options for the future provision of this service.

“The preferred option at Hafan Derwen has been identified because it offers the strongest benefits in terms of patient safety, clinical support and sustainability.”

Mr Carruthers stressed that no final decision had been taken.

He added: “Subject to Board approval, we will want to hear from staff, people with lived experience, carers, partner organisations and members of the public before any final decision is considered.

“Their feedback will be an important part of the process.”

Should the proposal be approved by board members, an eight-week engagement exercise would run from September 2 until October 26, 2026.

Staff, service users, carers, partner organisations and local communities would be asked for their views on the preferred option, its possible effects and any safeguards or mitigation that should be introduced.

The health board will consider the proposal at its meeting on Thursday, July 30. The meeting will be streamed online from 9.30am.

Almost 12,000 patients waited more than 12 hours in June as emergency doctors warned that a crisis once associated with winter had become a year-round emergency

WALES’ emergency departments have recorded their worst June for lengthy waits, with almost 12,000 patients remaining in major A&E units for more than 12 hours.

New NHS Wales figures show that 11,813 patients, equivalent to around one in six of those attending a major emergency department, waited more than half a day before being admitted, transferred or discharged.

Only 49 per cent of patients completed their journey through a major emergency department within four hours, the lowest proportion recorded and well below the NHS Wales target of 95 per cent.

Emergency doctors said the figures showed that a crisis once associated with the depths of winter had become a permanent feature of the Welsh NHS.

The Royal College of Emergency Medicine warned that patients were routinely being left on trolleys and chairs in overcrowded departments because hospitals did not have enough available ward beds.

Dr Rob Perry, the College’s Vice President for Wales, described the state of emergency care as “nothing short of shameful”.

He said: “We’re now in a situation where the majority of our patients are waiting more than four hours to pass through our department, and many are waiting more than half a day.

“This is an unacceptable state of affairs, and some of the worst waiting times since records began.

“I must be clear: no patient should wait 12 hours on a trolley, or a chair, in an overcrowded emergency department.

“Long waits like this are not only stressful and undignified, they are dangerous and put lives at risk.”

Crisis no longer confined to winter

The June figures are particularly concerning because they were recorded during summer, when hospitals are not yet dealing with the seasonal rise in flu, respiratory infections and cold-weather illnesses.

Dr Perry said: “Worse still, these are milestones which we are passing in summer.

“We aren’t even battling with flu or cold weather, but the wheels are coming off the bus anyway.”

The Welsh Government said June saw the highest number of emergency department attendances recorded for that month and pointed to additional demand caused by prolonged hot weather.

However, the Royal College argued that the number of people arriving at emergency departments was not the main cause of the deterioration.

Attendances fell compared with May and have remained broadly stable over the longer term.

Emergency doctors say the central problem is that patients who need admission cannot leave A&E because hospital wards are full.

Those wards may, in turn, contain patients who are medically well enough to leave hospital but cannot be discharged because the necessary social care, rehabilitation, equipment, home adaptations or suitable accommodation are not available.

The resulting blockage works backwards through the entire hospital.

Patients awaiting admission remain in emergency department cubicles or temporary treatment areas. Newly arriving patients cannot be moved into appropriate spaces, while ambulance crews may struggle to hand over those they have brought to hospital.

Patients trapped by hospital ‘exit block’

The Royal College describes the problem as “exit block”.

A patient may have been examined, treated and judged to need admission, but cannot be moved to a ward because no bed is available.

This can leave emergency departments attempting to provide ward-level care in spaces designed for short-term assessment and treatment.

Dr Perry said: “This is a fixable problem and we know what the causes are.

“Delayed discharges, and the accompanying lack of available beds in wards, are a serious problem, not the number of people arriving at our doors.

“Exit block makes it impossible for us to move patients in need of admission out of the emergency department.

“This complete breakdown in patient flow is causing untold misery for emergency department patients.”

Long waits do not necessarily mean a patient has received no medical attention. The NHS measurement covers the entire period between arrival and admission, transfer or discharge.

However, prolonged stays in crowded emergency departments can place patients at significant risk.

Frail and elderly people can become dehydrated, confused or physically weaker while waiting. Providing regular observations, medication, personal care and infection control also becomes more difficult when departments are caring for more patients than they were designed to hold.

Patients can be left without adequate privacy, while staff are forced to treat people in corridors, waiting areas and other unsuitable locations.

There is also a risk that conditions can deteriorate while doctors and nurses are simultaneously attempting to deal with new emergencies.

Social care pressures affecting hospitals

The problems facing emergency departments cannot be separated from the pressure on community and social care services.

Patients who are medically fit to leave hospital may still require home-care support, rehabilitation, a nursing or residential placement, specialist equipment or adaptations to their property.

When those services are unavailable, patients remain in hospital longer than clinically necessary.

That reduces the number of beds available for people waiting in A&E and contributes to congestion throughout the system.

Health and social care leaders have repeatedly warned of difficulties recruiting and retaining staff, particularly in rural areas, as well as shortages of suitable care placements and community support.

Simply discharging patients more quickly would not solve the problem if the necessary care is not available.

Patients must be able to leave hospital safely, with proper support in place to prevent them from deteriorating or being readmitted.

Pressure across west Wales

Hospitals serving Pembrokeshire, Carmarthenshire and Ceredigion are also affected by the wider pressures facing emergency care.

Withybush Hospital in Haverfordwest, Glangwili Hospital in Carmarthen and Bronglais Hospital in Aberystwyth serve large rural populations, with some patients living considerable distances from hospital, community care and specialist services.

The geography of west Wales can make it more difficult to arrange home-care visits, rehabilitation support and suitable placements, particularly when services are already facing staff shortages.

Patients discharged from hospital may also require transport, family support or changes to their homes before they can return safely.

Any failure in those services can result in hospital beds remaining occupied, even after treatment has been completed.

Ministers under pressure to deliver action

The new Welsh Government has said that reducing long waits and improving access to treatment are among its priorities.

Health and Care Minister Mabon ap Gwynfor described the latest performance as disappointing and unacceptable, while thanking NHS and social care workers for continuing to deliver services under intense pressure.

The Royal College said it welcomed the Government’s willingness to engage with emergency clinicians, but warned that discussions must now be followed by measurable action.

Dr Perry said: “The new Welsh Government has signalled that it understands the need to reduce long waits and overcrowding, and we are pleased that it is engaging with the Royal College on this issue.

“I hope, for our patients’ sake, that these words become action soon.

“As today’s figures show, the problem is only going to get worse without the proper interventions.”

The immediate test for ministers will be whether they produce a clear plan for reducing 12-hour waits, improving the movement of patients through hospitals and increasing the community and social-care capacity needed to allow people to leave hospital safely.

Without that intervention, Wales risks entering the coming winter with its emergency departments already experiencing conditions previously associated with the most difficult weeks of the year.

The crisis is no longer waiting for winter. It is already here.

Image:

Crisis point: Ambulances waiting to unload patients at Withybush Hospital, Haverfordwest, July 2026

Health board to consult patients over proposed permanent closure of nurse-led service at Shalom House

A NURSE-LED branch surgery in St Davids could be forced to close temporarily from the end of September after the building from which it operates was put up for auction.

Hywel Dda University Health Board has also confirmed that Meddygfa Penrhyn has submitted a formal application seeking the permanent closure of its branch surgery at Shalom House.

The practice applied to close the service in February, citing staffing difficulties and concerns about its long-term sustainability.

However, no final decision has been made, and the health board said patients, residents, staff and other stakeholders will be given an opportunity to express their views before the application is determined.

The situation has become more urgent after the trustees of Shalom House informed the health board that they intend to auction the premises.

The building will no longer be available for use as a surgery from the end of September 2026, meaning the branch could temporarily close while consultation takes place and alternative arrangements are considered.

Health officials stressed that the loss of the building would not automatically mean the permanent closure application would be approved.

The branch surgery opened in November 2024 and operates on weekday mornings. It is staffed by nurses and primarily provides services including blood tests and wound care.

Patients requiring a GP appointment currently travel to the main Meddygfa Penrhyn surgery, around three-and-a-half miles away.

The health board is drawing up an engagement plan with patient representative body Llais and the Local Medical Committee before formally seeking the views of the community.

Andrew Carruthers, chief operating officer at Hywel Dda University Health Board, said the organisation recognised the importance of accessible local healthcare.

He said: “We understand that residents may have questions about what recent developments mean for the future of the branch surgery.

“Our focus is on working hand-in-hand with our community to explore how we can ensure local health provision that keeps people well.

“We are keen to work with local stakeholders, including the Penrhyn Peninsula Working Group, to enable us to have a broader conversation about the future of our branch surgery and how it serves everyone in the area.”

Mr Carruthers said the health board was committed to hearing from as many people as possible before reaching a decision.

He added: “At this stage, no decision has been made regarding the closure application.

“We are committed to engaging with patients, residents and stakeholders to understand the potential impact of the proposal and to ensure that all views are considered as part of the decision-making process.

“Although we have been advised that Shalom House will no longer be available from the end of September, this does not predetermine the outcome of the branch surgery closure application.”

A final decision will take into account public feedback, evidence of local demand and the potential effect on patients.

Details of the consultation, including how residents can submit their views, are expected to be announced in the coming weeks.