Health board's fragile services need urgent change
Hospital services across a Welsh health board could be reorganised because they are so fragile.
Hywel Dda health board has included critical care, stroke services, eye care and urology among those in need of urgent attention.
Among the options would be to halve the number of acute stroke units and centralise planned urology cases and eye care.
A number of options will be given to the public, though the health board said it would welcome alternative suggestions as there was no preferred option.
It is understood each option put forward would come with a cost implication, but would be less than the current rising costs.
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Hywel Dda said changes were needed "because of the risks to them being able to continue to offer safe, quality services or timely care".
The four main hospitals in the area, which covers Pembrokeshire, Carmarthenshire and Ceredigion, are Prince Philip in Llanelli, Glangwili in Carmarthen, Withybush in Haverfordwest and Bronglais in Aberystwyth.
The health board said clinical teams were spread across multiple sites, over a wide geographic area, and there is an "over-reliance on a small number of individuals".
The nine areas deemed most fragile are:
Critical care
Dermatology
Emergency general surgery
Endoscopy
Ophthalmology
Orthopaedics
Radiology
Stroke
Urology
Hayden Harres, 65, said his local hospital, Glangwili, was "very good" but he would not want people to have to travel further for care.
"Distance is one factor, I think, especially for elderly people. If they have to travel further I don't think the care is better. I have every faith that the local hospital can provide the care that we need," he said.
Shadeen Lacaman, 27, from Haverfordwest, added she would support changes "as long as it's not too far from where you live".
The health board is not alone in facing challenges of reducing waiting times for treatment.
At a time when parts of Wales still have patients waiting longer than two years for care, it has removed those waits entirely, but still has more than 12,000 waiting longer than one year.
Staffing issues have improved predominantly due to the recruitment of international nurses, taking band five vacancies down from 280 whole-time equivalent to just 18.
The health board said that had substantially reduced its agency spend, but vacancies remained in other areas of its workforce.
Plans to update services were first drawn up in 2018 and while the pandemic increased demand, Hywel Dda has also had to contend with significant capital costs associated with issues around reinforced autoclaved aerated concrete (Raac) at Withybush Hospital.
A new hospital is planned for the area, but will not be built for at least 10 years after delays as well as the impact of inflation on construction costs.
Since the pandemic, there has also been an increased emphasis on regional working among health boards in Wales, meaning pressures can be spread across regions, though that also creates fresh logistical challenges.
Meanwhile backlog maintenance costs for an ageing estate continuing to rise, meaning doing nothing is not an option.
A previous report stated maintenance costs had increased from £60m to £255m since 2018, with £42m categorised as "high risk".
Glangwili and Withybush have the "most significant backlogs" at £90m and £72m respectively.
Any changes would be closely inspected by patients who are likely to face longer travel times for some services as a consequence, though the plans also include expansion in some areas and a greater role for primary and community services.
A public consultation on the options will be held over the summer with final plans expected to be put to the board by November.
Mark Henwood, executive medical director of the health board, said the reasons for the changes include difficulties in staffing services across all hospitals and the challenge of getting back to the same levels of treatments that were being delivered before the Covid pandemic.
Mr Henwood added: "Basically, we believe we're not delivering the highest standards of care to our patients."
He said: "These are not pre-determined options. We are going out to consult with our public about the services and to listen to their views about the services and if they identify options then of course we will consider those.
"No staff will lose their jobs during this process.
"This is not about saving money. This is about delivering the highest quality care to our patients."
Eiry Edmunds, deputy medical director, said clinicians are "anxious for progress and for change" and Senthil Kumar, the lead consultant for stroke services said changes are needed to improve standards of care in a health board where its geography is one of the "biggest issues".
The health board said: "Our 2024-25 end of year deficit was £24.1m, subject to audit.
"In previous years, spend was higher as a result of challenges faced during and following the Covid-19 pandemic, together with significant inflationary pressures.
"Focused effort by our teams, including reduced use of agency staff in the last financial year, and additional funding from Welsh government, has led to an improvement in our deficit position."
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