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Withybush: From full district hospital to “salami-sliced” services

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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2014 — Consultant-led maternity and SCBU withdrawn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.

 

Health

Have your say on new West Wales learning disability strategy

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RESIDENTS across Ceredigion, Pembrokeshire and Carmarthenshire are being invited to help shape a new regional Learning Disability Strategy.

Views sought on five-year plan

The strategy, covering 2026 to 2031, will set out the future direction of services and support for neurodivergent people and people with a learning disability across west Wales.

Over the past two years, Ceredigion County Council, Pembrokeshire County Council, Carmarthenshire County Council and Hywel Dda University Health Board have been working with people with lived experience to help shape the proposals.

At present, each county has its own Learning Disability Strategy. The new plan would bring these together into one regional approach, aimed at making services more consistent and joined-up across the three counties.

The draft recommendations have been developed and reviewed by the Regional Improving Lives Partnership, which includes the three county councils, Hywel Dda University Health Board, The Dream Team, Carmarthenshire People First, Pembrokeshire People First, the West Wales Regional Partnership, and projects funded through the Regional Integration Fund.

Cllr Alun Williams, Ceredigion County Council Cabinet Member for Through Age Wellbeing, said: “We’re committed to ensuring that people with a learning disability and neurodivergent people are at the heart of shaping services that affect them.

“We encourage everyone to take part and share their views to help us develop a strategy that truly meets the needs of communities across West Wales.”

The consultation is open until Sunday, July 5.

Residents can complete the West Wales Learning Disability Strategy Survey online, or request a paper copy from a Ceredigion library or leisure centre. Paper copies can also be requested by calling 01437 764551 or emailing [email protected].

Completed questionnaires should be returned to Norman Industries, Units 1-2, Snowdrop Lane, Haverfordwest, Pembrokeshire, SA61 1JB.

 

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Health

Withybush Emergency Department wins national award for green improvements

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WITHYBUSH HOSPITAL’S Emergency Department has won national recognition for work to cut waste, reduce emissions and save money.

The department, based at Hywel Dda University Health Board’s Withybush Hospital in Haverfordwest, has been awarded Bronze accreditation by the Royal College of Emergency Medicine as part of its Green ED programme.

The scheme recognises emergency departments which introduce practical changes to reduce their environmental impact while maintaining safe patient care.

At Withybush, the work was led by a small team made up of consultant Dr Vicki Hughes, resident doctor Dr Lizzie Caisley, ED secretary Janet Bird, and ED clinical fellow Dr Oyewale Osundeyi.

Their changes included replacing plastic medicine pots with paper alternatives, reducing unnecessary cannulas, improving waste segregation, and reviewing computer screen brightness and older equipment to identify where energy savings could be made.

Dr Osundeyi led a project to increase recycling and reduce waste sent for incineration.

He said: “Trying to reduce waste comes with a lot of challenges, because you are trying to change people’s habits and trying to make sure people understand the importance, but we were lucky to get a lot of people involved from the estates team to the nursing departments who helped us achieve this.”

The department also targeted unnecessary coagulation testing in admission bloods, a project led by Dr Caisley.

The change is expected to save around £30,000 a year, as well as cutting carbon emissions.

Dr Caisley said: “By reviewing our routine practices, I was able to identify simple changes that benefit both patients and the environment. It shows how quality improvement work can deliver meaningful financial and environmental savings.”

ED secretary Janet Bird supported the work by gathering information, co-ordinating meetings and helping to put sustainability plans into action.

She said she also created a Green ED information board and presented the programme at resident doctor induction sessions to raise awareness of the changes already introduced.

Dr Hughes said: “A group of individuals, cutting across resident doctors, nurses, administrative staff, and myself as a senior consultant, all got involved in this work.

“There were many different elements to achieving this bronze award. The next step is making sure the team is supported to build on it.”

Withybush was one of eleven emergency departments across England and Wales recognised through the programme.

Together, those departments are estimated to have achieved £216,000 in cost savings and 131,502kg of CO2e savings through more sustainable working practices.

Dr Ian Higginson, President of the Royal College of Emergency Medicine, said: “On behalf of the College – a massive congratulations to the team at Withybush General Hospital who have been awarded a Bronze accreditation through our GreenED programme.

“This accomplishment has been driven by a dedicated, innovative team, who have reduced emissions, as well as waste and saved costs – all to tackle the climate crisis.

“A healthier planet means healthier patients, and we have a duty to act to protect both.

“As a College, we are proud to support Emergency Departments across the UK, and beyond, in playing their part to become more environmentally friendly.”

 

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Health

NHS waiting lists falling — but west Wales faces fresh healthcare uncertainty

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Improving treatment figures welcomed, but local concerns grow over pharmacy changes, service reorganisation and access to care

WAITING times across NHS Wales are continuing to improve, according to the latest national figures — but patients in west Wales may question whether those improvements are being felt on the ground as concerns continue over changing local services, pharmacy provision and healthcare access.

New figures released by the Welsh Government show there were just under 666,700 referral-to-treatment patient pathways waiting to start treatment in March — down by around 21,300 compared with February and the lowest level recorded since August 2021.

It marks the tenth consecutive month that waiting lists have fallen, while the proportion of pathways waiting less than 26 weeks rose to 65.9 per cent — the highest figure since May 2020.

The average waiting time for treatment also dropped to 15.5 weeks, the lowest level since April 2020.

However, despite the improving national picture, NHS leaders have warned that Wales remains under significant pressure and that progress must not mask wider challenges facing the health service.

Responding to the figures, the Welsh NHS Confederation said scheduled care was “going in the right direction” but cautioned that emergency pressures, social care pressures and financial constraints remain major concerns.

The organisation’s director, Darren Hughes, said NHS leaders were ready to work with the new Welsh Government as part of its first 100 days in office, but stressed that reforms would require difficult decisions and honest conversations with the public.

He said: “While it’s not a perfect picture across the board, with high demand on urgent and emergency care, scheduled care waits continue to go in the right direction.

“Now is the time to build on this progress and make further inroads into the backlog of care that has built up in recent years.”

But for many people in Pembrokeshire, Carmarthenshire and Ceredigion, improving national statistics may feel at odds with the reality of healthcare closer to home.

Recent changes affecting community pharmacy provision, alongside continuing concerns over access to services, travel distances and healthcare reorganisation within the Hywel Dda University Health Board area, have left some residents questioning whether NHS recovery is being experienced equally across Wales.

Community pharmacy provision has become an increasing concern locally following recent changes affecting some chemist services, raising fears over access to medication and frontline healthcare support — particularly in rural areas where alternatives may involve lengthy travel.

At the same time, debates around the future location of services, staffing shortages and the long-term sustainability of care in west Wales continue to generate concern among patients and campaigners.

For many residents, the NHS debate is no longer only about waiting times — but whether services remain accessible in the first place.

The figures also require some caution. NHS waiting-list totals are measured in “patient pathways” rather than individual patients, meaning one person can appear on the list more than once if waiting for multiple treatments or appointments.

The Welsh NHS Confederation warned that any future improvements would need a “whole-system approach”, involving primary care, community healthcare and social care, alongside action to reduce demand before patients require hospital treatment.

Mr Hughes added that NHS organisations also face tightening budgets and renewed inflationary pressures linked to global events.

He warned: “NHS leaders will need clarity from political leaders on a focused set of priorities and the backing to make the difficult decisions required to reform services, being honest with the public around timelines and expectations.”

Professor Jon Barry, Director in Wales at the Royal College of Surgeons of England (RCS England), said: “The new Welsh Government inherits a significant challenge, and these figures reflect the reality across Wales – long waits, repeated delays, and too many people left in pain. 

“There were commitments during the election campaign to develop a clear plan for expanding elective capacity, including early work to establish new surgical hubs across Wales. The priority now is to start delivering on those plans without delay. 

“More surgical hubs will help bring down long waits and ensure fewer patients are left dealing with uncertainty and disruption to their daily lives while they wait for treatment.” 

The Herald has approached Hywel Dda University Health Board for comment on how improving national waiting-time figures compare with the experience of patients in west Wales, including concerns around pharmacy provision, service changes and access to local care.

The Welsh Government has also been asked what the new administration’s healthcare priorities will mean for communities in rural Wales over the coming months.

Welsh Government response

The Welsh Government said it had pledged to “pick up the pace” to ensure people across Wales are seen faster for NHS treatment.

Health and Care Minister Mabon ap Gwynfor said: “Too many people are waiting too long for NHS treatment. That is the reality and it is an issue we are determined to fix.

“It is people’s lives we are talking about – and my job is to make sure the Welsh Government works closely with the NHS to ensure people who need treatment get it much quicker.”

The new minister said improvements were needed not only in waiting lists, but also in ambulance response times and emergency department access.

The Welsh Government said it would commission an independent review of NHS performance in Wales within its first 100 days, with a particular focus on the impact of waiting lists on population health.

It also plans to set up an expert task group to develop plans for up to ten new elective care hubs across Wales, with a delivery plan due by the end of 2026.

Mr ap Gwynfor added: “Today’s figures are a starting point. We will be honest with the people of Wales about the progress we make, and we will rightly be judged on results. We intend to meet the scale of the challenge ahead.”

 

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