1.38 For those who preferred it, Option A was seen as the easiest to resource; and to offer opportunities for stronger specialist staffing, improved standards of care, and better patient outcomes across Hywel Dda. In this context, many consultees said they would be happy to receive critical care at a hospital further from home if this care was of the best possible quality.
1.39 Those in opposition believed Option A would reduce local access to critical care services (a particular concern for Pembrokeshire-based participants) and increase patient transfers. In relation to the latter, key worries were around the risks of transferring critically ill patients over long distances across poor road networks, and the emotional and financial burden on families having to travel further to visit loved ones.
1.40 Strong concerns were raised by Withybush staff, who argued that changing the hospital’s ICU to an ECU would have significant implications for patient safety, service sustainability and staff morale. A particular concern was that it would be difficult to maintain an emergency department without an ICU at Withybush. This was also echoed at the public and patient drop-in events and meetings: attendees feared that losing ICU functions could make Withybush a less attractive place to work and accelerate workforce decline.
1.41 There was also widespread concern about the capacity and deliverability of centralising intensive care for the south of Hywel Dda at Glangwili, the ICU at which is already operating at full capacity and would struggle to safely accommodate additional patients.
1.42 Less feedback was given specifically on Option B. It was often viewed as a compromise option, balancing accessibility and feasibility and reducing patient transfer needs. However, its success was still seen to be heavily dependent on solving the Health Board’s workforce challenges.
1.43 Some also said that current critical care facilities at Withybush are outdated and would need investment for Option B (and Option C) to be fully realised. On the other hand, a few questionnaire respondents felt that Withybush ICU staff skills and morale would be improved if the decline in other onsite surgery was reversed.
1.44 Option C was seen by some members of the public and a few staff members as the most equitable and responsive to local need, the least disruptive, and the option that would require the fewest patient transfers. It was also said to be the option that offers most resilience in view of major incidents and any future pandemics.
1.45 However, many consultees across the different consultation methods questioned whether this option is deliverable or sustainable within the context of existing workforce and resource constraints. Indeed, the scale of the recruitment required - particularly for consultants - was often considered unrealistic. The Welsh Critical Care Network particularly stressed that patient safety risks associated with the current staffing deficits require clearer communication, noting that maintaining multiple ICUs without sufficient consultant presence may compromise the quality of care.