1.198 Consultees proposed several mitigations that could strengthen any chosen model:
- regional partnerships with Swansea Bay University Health Board to leverage tertiary services at Morriston.
- ring-fenced stroke beds and enhanced therapy staffing.
- dedicated stroke transfer vehicles with trained paramedics and guaranteed availability.
- clear clinical pathways for imaging, monitoring, transfers, and repatriation.
- fully integrated hospital-to-home pathways, underpinned by robust community, therapy, and social care capacity.
- telemedicine-enabled pathways to reduce unnecessary transfers.
- deploying specialist staff across sites to reduce patient travel.
- family accommodation near specialist centres.
- examine good practice within stroke services in other rural areas.
1.199 Consultees proposed other potential alternatives and suggestions, including the following:
- a rural stroke hub for mid Wales at Bronglais providing acute care and rehabilitation capacity in close collaboration with Betsi Cadwaladr University Health Board and Powys Teaching Health Board.
- a specialist stroke rehabilitation unit at Bronglais, or at the Llanbadarn Campus in Aberystwyth.
- a north/south model: one centre at Bronglais and one at Glangwili or Prince Philip.
- configurations involving three stroke units rather than the two proposed.
- a 24/7 stroke unit at Glangwili, not Prince Philip, as the former is in a central location and has existing on-site emergency and specialist services, concentration of stroke expertise, and stronger imaging and therapy infrastructure.
- invest in facilities at Glangwili e.g., extend the Gwenllian ward to provide more stroke beds and relieve pressures to transfer patients quickly.
- retain a stroke unit at Glangwili (perhaps using Padarn Ward, which currently cares for respiratory and general medical patients and could be moved to ‘Y Lolfa, an alternative care unit) and provide rehabilitation at Prince Philip.
- maintain four units: with 24-hour specialist care at Prince Philip and 12-hour care at each of the three remaining hospitals.
- variations on Option B which would see a 24-hour unit at Withybush instead of Prince Philip (given the latter’s proximity to Swansea Bay); or only have 24-hour cover at Prince Philip or Withybush.
- Option A, but with the two units alternating 12-hours of specialist cover to achieve 24-hour provision.
- stroke consultants working on rotation to cover more sites.
- implement a phased or hybrid approach based on both Options i.e. start with 12-hour cover at both chosen sites (Option A) and gradually extend to 24-hour care as staffing levels improve.
- integrated acute and rehabilitation units in each county, ensuring local, person-centred recovery and staffing sustainability.
- a level 2/therapy-led rehabilitation unit somewhere in the Health Board for patients who need rehabilitation in a 24-hour supported setting but who no longer need medical-led care.
- a mobile unit for use across the region.
1.200 In addition, the Stroke Association, staff, and some public and patient drop-in/meeting attendees called for clearer alignment with the National Stroke Programme (in collaboration with partner agencies and stroke survivors) before any changes are implemented. On a related note, some questionnaire respondents suggested a more regional or all-Wales approach to stroke care by, for example, creating a regional Comprehensive Regional Stroke Centre (CRSC) at either Morriston or Glangwili.
1.201 For further details, see the stroke sections in the individual consultation method chapters.