Hywel Dda 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.

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

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.