1.87 Consultees proposed several mitigations that could strengthen any chosen model:
- adequately resourced inter-hospital transfer services that can facilitate same-day transfer of all urgent cases.
- daily senior surgical review on all sites (including non-operating sites) to support assessment, stabilisation, and early clinical decision-making to ensure only necessary transfers happen.
- prompt post-surgical repatriation to Withybush and regular post-surgical specialist review.
- provide clear commitments on infrastructure investment - including diagnostics, beds, theatres, and staffing - at the affected hospitals.
1.88 Consultees proposed other potential alternatives and suggestions, including the following:
- maintain on-site emergency surgical capability at all acute hospitals where possible.
- either full emergency general surgery, or potentially Surgical Same Day Emergency Care (SDEC) , at Prince Philip.
- explore rotational consultant models (rather than rotating the full emergency service).
- relocate specialist roles rather than whole teams, for example basing endoscopists at Withybush to maintain local expertise.
- increase elective and day-case surgical throughput at Withybush, drawing on underused facilities (e.g., Ward 9 and several theatres) for procedures such as hernia, gallbladder, gynaecological, and colorectal surgery.
- use the former Preseli Theatre in Withybush as a Surgical Same Day Emergency Care (SDEC) centre.
- keeping emergency general surgery services available all the time at Withybush, and removing or reducing services at Glangwili instead.
- a main hub at Glangwili for complex cases but with same day surgery/less complex cases remaining at each local hospital.
- consolidating on just one single site for all surgery.
- strengthen Surgical Same Day Emergency Care (SDEC) at Bronglais, as well as at Glangwili and Withybush.
1.89 For further details, see the emergency general surgery sections in the individual consultation method chapters.