A healthier mid and west Wales - frequently asked questions

One of the key challenges we face is the fragility of some of our services. This is particularly the case in maintaining so many medical rotas, and this means that we cannot continue to run all acute services at both Glangwili and Withybush hospitals. 

We have had to respond to changing needs and expectation on our doctors during the last 20 years and our doctor on-call rotas have had to change. To improve training opportunities and performance, doctors both in training and at consultant level are expected to be on-call less frequently and work fewer hours than in the past. At the same time, standards and expectations of care have increased, with timely access to senior decision-makers required to assess patients in our hospitals throughout the week and weekend. Other health organisations in Wales and across the UK can offer less frequent more attractive on-call rotas.

This has all resulted in a challenge for the health board in providing enough doctors in all our hospitals to continue to provide services. This means we rely too much on temporary staff to deliver services. This is not the safest way to provide care. It is also expensive and whilst money is not an overriding factor in why we need to change, it plays a significant part in us being able to provide better healthcare and to better support services in community and primary care.

Another benefit of aligning some of our specialist staff, is allowing them the opportunity to see sufficient patients to maintain and build their expertise in certain areas and to work in networks. This will bring opportunities to provide a wider range of services within Hywel Dda than is currently possible. By providing and supporting specialisms we can provide safer services and improve outcomes for patients.

Of course, it’s not only medical staff where we have challenges to recruit, this is also true in nursing and other professions. We routinely can have as many as 950 whole time equivalent vacancies (which is about 10% of our staff). This makes some of our services very fragile, difficult to sustain and not the highest quality that we want to provide.

Bronglais, Glangwili, Prince Philip and Withybush hospitals will continue to provide a range of important services for the local population, alongside the new Urgent and Planned Care Hospital in the south of our area. This means that  people’s care would predominantly still be provided locally.

This would not address the problems we have with maintaining our medical rota, nor some of the problems we have with the buildings, particularly at Glangwili Hospital.

Whilst we have upgraded our current hospitals to keep them safe and functional, they do not address the fundamental service re-design necessary for us to meet modern healthcare standards in the future. For example, our theatres are too small, we do not have enough single rooms, nor facilities that support rehabilitation, such as in wards.

In our PBC the “do minimum” option estimates we could spend up to £655m on our buildings and still not be able to provide the standards required to deliver modern healthcare or the flexibility needed for the future.

For detail on our challenges with medical rotas see question Why do we need a new hospital, why can’t you upgrade the ones you have?

In our option development stage (prior to formal consultation in 2018), options to provide emergency and urgent care for the south of Hywel Dda either from Withybush Hospital, in Haverfordwest, or Glangwili Hospital, in Carmarthen, were considered.

They were eliminated due to the distance of travel for this type of care that would be required for people in the neighbouring county (i.e., travel too great for people in Carmarthenshire when sited at Withybush and travel too great for people in Pembrokeshire when sited in Glangwili).

We know that people from coastal Pembrokeshire must travel to Glangwili Hospital for a range of urgent and emergency services now which has been a driver to move the main emergency unit further west. However, if the main emergency unit is too far west then it would affect access for the population in north Carmarthenshire and some services such as obstetrics and paediatrics (and therefore other services) would not have enough activity to be sustainable and may be lost completely.

Our proposals for the new hospital, were mapped to ensure we provide an emergency service that is as close as possible to being within an hour of most populations in our area. This is how we arrived at the zone for the new hospital, somewhere between St Clears and Narberth. Whilst no land has been purchased for the new hospital site, a land selection process has started.

A new hospital alone will not be enough to address our challenges and deliver the vision we aspire to for our communities. That is why our PBC includes a huge focus on improvements in the heart of our communities, and support for our strategy to shift focus to prevention, early intervention, and care as close to home as possible.

If supported, a new hospital will however provide many opportunities for us to improve care for our population. Glangwili and Withbush Hospitals are some of the oldest in Wales and don’t meet the standards for modern health care buildings. This impacts on patient experience and the quality of services we can provide. Equally the duplication of services across sites means many are fragile and don’t have the necessary scale to provide care in the way we would want (7-day cover for example).

We also believe there are additional services we could offer from a new hospital, within the boundaries of Hywel Dda, which we are not able to now. We are keen to explore, in conjunction with Swansea Bay University Health Board, options for providing some tertiary services, for example radiotherapy, neurology services, and cardiac catheterisation services. Each of these services is being reviewed regionally through the ARCH partnership.

The experience we have seen in other places where there has been a new hospital is that staff want to go and work there as they have the latest facilities and technologies. It would also allow us to offer more attractive rotas to medical staff and trainees. We propose to have a health education, academic and research and innovation facilities on the site, including an Institute for Life Sciences. It is not just about doctors; we have had discussions and want to work closely with health sciences to train and attract nurses and therapists too.

By having a stable workforce, we will have more senior, specialists available at the front door so patients have quick access to them, as well as all the support services needed. We will also reduce our reliance on temporary staff, which is costly and can result in less safe service provision.

Finally, by separating planned and emergency care, as we intend to at the new hospital, we will avoid the risk of emergency activity negatively impacting on planned care, through cancelled operations.

We are keen to explore, in conjunction with Swansea Bay University Health Board, options for providing services that are tertiary, for example radiotherapy, neurology services, and cardiac catheterisation services. Each of these services is being reviewed regionally through the ARCH partnership.

The Urgent and Planned Care Hospital would provide specialist mental health and learning disability services 24/7. This would include beds for adults, older adults, children, and adolescents, learning disabilities, psychiatric intensive care, male low secure beds, and assessment and day facilities, as well as dedicated and appropriate section 136 suites.

Facilities should be provided in a dedicated unit, ideally with connectivity to the main hospital site. This unit will be an integral part of the overall mental health service offering, specialist input in addition to that provided within community facilities.

Bronglais Hospital would continue to have older adult mental health beds as it does now.

NB for questions on site selection and purchase of land, please see chapter above on process.

No, the Board met after thoroughly considering the independent review of consultation feedback from the public. The Board reduced the shortlist from three sites to two. The chosen sites, still being considered are Tŷ Newydd, Whitland, and the site at St Clears.

These sites were chosen following consideration of the consultation report, Equalities Health impact Assessment, Technical, Biophilic, Clinical and Workforce appraisals. It was decided that site at Whitland Spring Gardens would not be taken forward for further consideration.

Our health board staff, partner organisations, and the broader community were asked to share their views on three potential site options for a proposed new urgent and emergency care hospital; two located near Whitland and one near St Clears. This was carried out for a period of 12 weeks from 23 February to 19 May 2023 with responses being gathered in a number of ways including by telephone, using paper surveys as well as online, and at public consultation events across Carmarthenshire, Ceredigion, and Pembrokeshire. A number of focus groups were also held with stakeholders. Consultation information was made available in alternative languages and formats to enable participation of as many people as possible and to capture a diverse range of views during the consultation period.

 Opinion Research Services (ORS) was commissioned to independently advise, collate, and manage the consultation responses. Their comprehensive report on the consultation findings (opens in new tab)is now available for review on the health board’s website.

Withybush is part of our longer-term strategy as outlined in A Healthier Mid and West Wales. Our vision is that Withybush will be repurposed and continue to provide a range of services to our community. However, we are aware that several areas of Withybush hospital are old and need considerable work - the discovery of RAAC is further evidence of this.

The development of the proposed new Urgent and Planned Care Hospital in the south of our Hywel Dda area will take a number of years to complete. We are making progress in narrowing down the location for our new hospital, but it will not be ready for some time. In the meantime, we continue to see increased demand on our hospitals and closing Withybush is not planned.

The health board will continue with its planning and development process. On the basis that the Programme Business Case receives endorsement from Welsh Government, the Strategic Outline Case will be presented to Board, and is the next step in attaining funding and support.

Discussions are currently ongoing with Welsh Government on the content of the Strategic Outline Case and this will determine the timescale for the completion of the next stage, including when it will be presented to Board.