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.

Paul Davies vows Senedd fight as fears grow over travel times and patient safety

PEMBROKESHIRE patients will be forced to travel further for lifesaving treatment after a controversial decision to remove emergency general surgery services from Withybush Hospital.

The move was confirmed following an extraordinary two-day meeting of the Hywel Dda University Health Board held on Wednesday and Thursday (Feb 18–19), where senior officials took decisions on nine services as part of the organisation’s long-running Clinical Services Plan.

The decision has sparked immediate political backlash, with local Senedd Member Paul Davies condemning the outcome and warning it represents another major blow to healthcare provision in Pembrokeshire.

Mr Davies said: “I’m extremely angry that Hywel Dda University Health Board has once again decided to remove services from Withybush Hospital,” he said.

“Patients will now have to travel for emergency general surgery services and it’s another example of the Health Board doing whatever it wants, against the will of the people of Pembrokeshire.

“This is the latest in a long line of services that has been stripped from the hospital over the years and is further evidence that the Health Board is pushing a centralisation agenda that

punishes the people of Pembrokeshire.”

Commenting, Welsh Conservative Shadow Cabinet Secretary for Health and Social Care, Peter Fox MS, said: “This will be concerning news for patients and families in Ceredigion and across mid and West Wales.

“Downgrading emergency general surgery services in the area will mean longer journeys for urgent care, increasing pressure on patients, families and ambulance services.

“The Health Board must focus on investing in local infrastructure and ensuring safe, timely access to care, rather than centralising services and leaving communities facing longer travel times in critical situations.”

Also Commenting, Local Welsh Conservative Senedd Member Samuel Kurtz MS said: “Residents in Pembrokeshire and Ceredigion are being treated like second class citizens, as it is always us in the West that has to see our services cut.

“The salami slicing of services is exactly what the Labour government have wanted, and the health board are delivering. This is a sad day, and residents will rightly be angry and concerned.”

Kerry Ferguson, Plaid Cymru Senedd election candidate for Pembrokeshire said: “We are so disappointed with the Health Board’s decision to remove the current emergency general services from Withybush. Whilst the Board has committed to maintaining and strengthening Same Day Emergency Care, residents of west Pembrokeshire will still face at least an hour’s journey to receive emergency operations or significant treatment.

Residents in Pembrokeshire are rightly worried and anxious about the services Withybush might lose, and losing their emergency general services is a huge blow.

I call on the Health Board to urgently reconsider their decision, and to take into account the risks and impact that implementing option A will have on residents of Pembrokeshire.”

Clinical Services Plan

Last year, the Health Board consulted communities across west Wales on proposed changes to nine services considered “fragile and in need of change,” including critical care, dermatology, emergency general surgery, endoscopy, ophthalmology, orthopaedics, stroke, radiology and urology.

The consultation covered the region’s four main hospitals — Withybush in Haverfordwest, Glangwili in Carmarthen, Prince Philip in Llanelli and Bronglais in Aberystwyth.

Health chiefs previously said the services were selected because of risks around sustainability, staffing and the ability to deliver safe, timely care.

During the consultation process, communities submitted around 190 alternative ideas, later narrowed down to 22 potential options for consideration by board members.

What the decision means

Following the board’s decision, emergency general surgery operations will no longer take place at Withybush Hospital.

However, the Health Board says same-day emergency care (SDEC) services at Withybush will be strengthened.

For the other hospitals in the region, there will be no change to emergency general surgery provision, apart from an expansion of same-day emergency care at Glangwili Hospital.

Board members stressed that the changes would not happen immediately.

Chief Executive Phil Kloer told the meeting the proposals were aimed at “improving the quality of service for the public,” adding that a Pembrokeshire-preferred option — alternating emergency surgery between Withybush and Glangwili on different weeks — had raised safety concerns among clinicians and managers.

Other service changes

The board also backed changes to critical care services.

Under the plans, intensive care provision will remain unchanged at all hospitals except Prince Philip Hospital in Llanelli, where the intensive care unit will be replaced by an enhanced care unit, with the sickest patients transferred elsewhere.

Political backlash

Mr Davies said he was “appalled” by the outcome.

“The Health Board is obsessed with removing services from Pembrokeshire and has spent years downgrading and removing services from Withybush Hospital,” he said.

“As one constituent has rightly said, the Board should be rebranded the Carmarthenshire Health Board, as it continues to strip assets from other hospitals in west Wales.”

He warned the decision could undermine emergency care locally.

“Removing general emergency services critically undermines the sustainability of Withybush Hospital’s A&E department and will result in patients having to be transported for urgent treatment.

“This is not acceptable – I will be taking this to the Welsh Government and urging Ministers to intervene and stop the Health Board from making this catastrophic decision.”

Wider concerns

The removal of emergency general surgery from Withybush is likely to reignite long-running concerns about healthcare access in west Wales, particularly around travel distances, ambulance pressures and the resilience of rural health services.

Campaigners have repeatedly warned that losing specialist services increases risks for patients facing time-critical conditions.

A full statement from the Health Board is expected following the conclusion of the meeting.

Board papers and meeting information are available via the Health Board website.