GLANGWILI HOSPITAL in Carmarthen is set to face a surge in demand as it becomes the main provider of children’s healthcare services for the entire Dyfed region, following significant changes in paediatric care at Withybush Hospital in Pembrokeshire and Bronglais Hospital in Ceredigion. This centralisation has raised concerns about how Glangwili will manage the influx of young patients from all three counties: Carmarthenshire, Pembrokeshire, and Ceredigion.

The closure of the Paediatric Ambulatory Care Unit (PACU) at Withybush Hospital in Haverfordwest was recently made permanent, leaving families in Pembrokeshire without local access to hospital-based care for children. This decision came after the unit’s hours were reduced in 2016 and its services were “temporarily” transferred to Glangwili during the pandemic, only to never return. Hywel Dda University Health Board cited financial and staffing constraints as the main reasons for this closure, leaving Glangwili as the sole 24-hour inpatient paediatric facility in the region.

Adding to the strain, Hywel Dda University Health Board has announced that children requiring more than 24 hours of care at Bronglais Hospital in Aberystwyth will also be transferred to Glangwili, starting 1 November 2024. This temporary measure, expected to last six months, is a response to a shortage of paediatric nurses at Bronglais. However, families fear that the increased burden on Glangwili could have long-term consequences for children’s healthcare in Dyfed.

The announcement has been met with concern from local politicians and community members. Ceredigion MS Elin Jones described the decision as a “real shock,” warning of its impact on families in the region. “This will cause real concern to ripple through the community,” she remarked, emphasising the need to ensure the change remains temporary. Many residents also fear the decision sets a worrying precedent for the future of paediatric care in Ceredigion.

Dr. Gwen Rees criticised the decision, stating it could lead to “poorer health and wellbeing outcomes” due to limited access to inpatient care. Highlighting the challenges faced by families in rural areas, Dr. Rees noted that the transfer to Glangwili poses logistical and emotional difficulties, particularly for those living over an hour away.

With the upcoming changes, Glangwili Hospital now faces the task of providing paediatric care to the entirety of the former county of Dyfed. Encompassing Carmarthenshire, Pembrokeshire, and Ceredigion, this is a vast and largely rural area, making travel to the hospital difficult for many families. In some cases, parents may now face journeys of over an hour to access hospital care for their children, a situation that is particularly concerning for emergencies and those requiring ongoing treatment.

Parents and local campaigners have expressed their dismay, arguing that the centralisation of services at Glangwili could compromise the quality and timeliness of care for children across the region. Residents of Pembrokeshire and Ceredigion have already voiced their frustrations over the closure of Withybush’s PACU, pointing out that previous “temporary” reductions in services often become permanent. The prospect of Glangwili now having to handle patients from all three counties has only heightened their concerns about the sustainability of paediatric healthcare in west Wales.

In response, Hywel Dda University Health Board has assured the public that the changes are necessary to address staffing shortages and financial challenges while ensuring safe care delivery. Dr. Prem Kumar Pitchaikani, Clinical Director for Women & Children’s Services, emphasised that the adjustments at Bronglais are a “short-term operational change” meant to prioritise the safety of patients and staff. However, many families remain sceptical, especially given the history of gradual service reductions at Withybush.

The health board has also promised to support families affected by these changes, including providing designated ambulance vehicles and exploring other transport solutions. Despite these efforts, the reality of centralising care at Glangwili raises questions about how effectively the hospital can manage the increased patient load without compromising the level of care.

As the changes take effect, communities across Carmarthenshire, Pembrokeshire, and Ceredigion will be watching closely to see how Glangwili Hospital adapts to its new role as the main paediatric care provider for the entire Dyfed region.

HYWEL DDA University Health Board has approved a proposal to replace inpatient beds at Tregaron Community Hospital with enhanced community-based healthcare services. This decision comes after a public engagement exercise and is part of the Cylch Caron project aimed at transforming healthcare delivery in north Ceredigion.

The approved model will see the removal of nine inpatient beds at Tregaron Hospital, shifting focus to providing care in or close to patients’ homes. According to the health board, this move is designed to create a more sustainable, safer service across Ceredigion, improving patient care and allowing people to avoid hospital stays unless necessary. The model will allow staff to work in different ways, offering more support in the community and strengthening community-based nursing services.

A vision for integrated care

The Cylch Caron project, a collaborative effort between Ceredigion County Council, the health board, and the Welsh Government, plans to establish an integrated resource centre in Tregaron. This centre will bring together healthcare, social care, and housing services in a central hub for the town and its surrounding rural areas. The health board believes this model is already successful in south Ceredigion and will provide high-quality patient care by enhancing collaboration across healthcare and support services.

Peter Skitt, County Director for Ceredigion, acknowledged the emotional attachment the local community has to Tregaron Hospital. “We want to do the right thing for our patients and our staff who care for them, and this isn’t always by the traditional model of providing care in a hospital bed,” Skitt said. The health board aims to use the new model to support up to 40 people in their homes, compared to the nine patients who would be accommodated in hospital beds.

Despite the health board’s assurances, the plan to remove inpatient beds has sparked significant concern within the community and among local politicians. During the public engagement period, fears were raised about the future of healthcare services in Tregaron.

Elin Jones, Member of the Senedd for Ceredigion, and Ben Lake, the local MP, have been vocal in their concerns. They argue that the inpatient beds at Tregaron Hospital should remain until the new Cylch Caron centre is operational. “It was always expected that beds would remain in use at Tregaron Hospital until the Cylch Caron project was up and running,” said Elin Jones. The delay in the project’s completion, now expected to take another three to five years, has led to worries about a potential gap in healthcare provision.

Similarly, Tregaron Town Council has expressed “disappointment and anger” over the health board’s decision, stating that decommissioning the beds before the Cylch Caron project opens could dilute local healthcare resources. Tregaron County Councillor Ifan Davies described the hospital as a “special resource for the area,” emphasising its long-standing role in providing care to the community.

The Health Board’s justification

The health board, however, remains firm on the benefits of the new model. It argues that the change will help avoid the risks of hospital stays for patients who are medically fit to be in their home environments. The board has also noted that the staffing situation at Tregaron Hospital has become fragile, with recruitment efforts failing to address the shortages. “Despite efforts to recruit to positions, our current level of staffing is insufficient, and our staffing rotas are fragile,” said Skitt.

This proposal, according to the health board, is an opportunity to strengthen its resilience ahead of the winter months when healthcare services face significant pressures. By adopting the community care model now, they aim to avoid a situation where they might be forced to close beds without notice.

The transition to the new model of care will be phased. Current inpatients at Tregaron Hospital will follow normal discharge procedures, and further admissions will cease immediately. The hospital building will continue to serve as a hub for community staff and as a facility for outpatient services until the integrated resource centre is operational.

Dr Sion James, Deputy Medical Director of Primary Care and a local GP, supports the Cylch Caron vision. He describes the project as a unique opportunity to offer a range of services in a central hub for Tregaron and surrounding rural areas, aiming to create an innovative, sustainable model of community-based care.

While the new community healthcare model promises to provide enhanced nursing support in patients’ homes, local politicians and residents remain concerned about the potential loss of a valued healthcare facility. The health board’s assurances of a safer, more sustainable service will be tested in the coming months as Tregaron’s community adjusts to these changes. For many, the focus now shifts to how well the new model will meet the area’s healthcare needs in practice, especially as the Cylch Caron centre remains years away from completion.

ALMOST three quarters of haematology consultants in Wales will near retirement age in the next decade, with a critical shortfall of replacements, a charity warned. 

Blood Cancer UK (BCUK) launched an action plan, entitled ‘Taking blood cancer out of the shadows’, at the Pierhead in Cardiff Bay on September 24 

Ceri Bygrave, a consultant haematologist at the University Hospital of Wales, Heath, Cardiff, was part of the charity’s task force which produced the recommendations. 

Dr Bygrave said: “The haematology workforce is overstretched and understaffed, with critical staff shortages and increasingly complex treatments leaving people delivering NHS blood cancer care under major pressure. 

“This is a particular challenge in Wales where by 2032, 74% of permanent haematology consultants will reach the age of 60 with a shortfall in trainees to replace them.” 

Dr Bygrave said: “The crumbling NHS infrastructure that exists in Wales and a woeful IT infrastructure that lags a long way behind other centres in England are all things that compromise blood cancer patient care on a daily basis. 

“To improve blood cancer survival, future NHS workforce plans must include an increase in the number of and support for blood cancer clinical nurse specialists, as well as action to turn around the drop in the number of clinicians doing blood cancer research.” 

Helen Rowntree, the charity’s chief executive, said huge strides have been made in research in the past 60 years but blood cancer remains the UK’s third largest cancer killer. 

Ms Rowntree said: “Needless lives are being lost and for those living with blood cancer there’s a real fear that they’re not getting the best care and support. 

“The blood cancer community deserves better. The drivers of better survival in high-performing countries urgently need to be understood and implemented.” 

Sam Rowlands, the Conservatives’ shadow health secretary, said blood cancer requires more attention in Wales as he called for targeted intervention. 

Mr Rowlands said: “Barely half of cancer patients are receiving treatment within the 62-day target time in Labour-run Wales and there is no clear trend of improvement.

“The action plan from BCUK provides a blueprint for bold action, the fact that only one hospital in the whole of Wales provides groundbreaking CAR-T therapy isn’t good enough. 

“If we boost staffing levels as the Conservatives have proposed and invest in provision, we can also put forward a faster diagnostic standard, as is the case in England, of 28 days. 

“We should also have more ambition in collecting information on cancer treatments in Wales to perfect treatments and improve prospects.” 

David Rees, who sponsored the event and chairs the Senedd’s cross-party group on cancer, described the charity’s report as sobering. 

He said the report highlights the complexity in diagnostics and treatment which often leads to missed early diagnosis, treatment disparities within Wales and gaps in clinical expertise. 

The Labour MS for Aberavon added: “I know that there are issues involved in data collection for blood cancer too, which can help inform good clinical practice and patient pathways.” 

Mr Rees said: “Patients across Wales need to have confidence … that when they present themselves to their GP or A&E department, the diagnostic services are available and can deliver timely data that can lead to early treatment. 

“Patients should expect no less.” 

He pledged to keep pressure on ministers to act on expert reports, saying he was confident two Labour governments can together meet the challenge of modernising the NHS. 

Research found 29% of people with blood cancer in Wales visited their GP three or more times before diagnosis, with BCUK warning delays can have devastating consequences. 

The charity also raised concerns that nearly 30% of blood cancer patients in Wales do not know who their clinical nurse specialist is. 

The Welsh Government highlighted a 50% increase in haematology specialty and associate specialist doctors, and a 9% increase in consultants over the past decade. 

A spokesman said: “We have made cancer one of the NHS’s top planning priorities and have launched a national programme to support recovery in cancer waiting times. 

“We have received the charity’s blood cancer action plan and are considering the implications for our approach in Wales.”