1.179 There was broad recognition that Hywel Dda faces significant workforce, capacity, and sustainability challenges in delivering safe, modern stroke care. Many accepted that the current system - spread across multiple small units - cannot consistently meet national standards for rapid assessment, 24/7 specialist input, or intensive rehabilitation.
1.180 Considering this, many consultees across the different activities recognised that centralised specialist stroke centres can deliver improved survival and recovery rates; and so supported the principle of centralisation, suggesting that they would prefer stroke services to be provided at an appropriate specialist centre, regardless of location, rather than at a non-specialist hospital closer to home. This support was on the proviso that the proposed stroke units are adequately resourced and complemented by strong community-based rehabilitation, and that patients are moved back to a hospital closer to home for the latter parts of their recovery. In this context, more and clearer information on proposed stroke pathways (including repatriation and rehabilitation) and workforce plans was desired by consultees.
1.181 Many others, though, felt that the proposed changes fail to account adequately for the realities of rural Wales - long travel distances, poor roads and public transport links, and an older demographic profile. These issues are discussed further below.