Withybush Hospital will be downgraded or “repurposed” as part of Hywel Dda Health Board’s controversial shake up of services, it has been confirmed.

Following consultation this summer there were ten recommendations approved by the health board at an extraordinary ‘Transforming Clinical Services’ meeting at Carmarthenshire County Council’s offices today (Wednesday).

The key recommendations include the plan to build a new urgent and planned care hospital somewhere between Narberth and St Clears and retained acute hospital services at Bronglais in Aberystwyth.

Both Withybush and Glangwili General Hospitals will be “repurposed” to offer a range of services to support as social model for health and well-being, designed with local people to meet their needs.

In a change to the proposed option consulted on acute medicine services will also be retained at Prince Philip Hospital in Llanelli.

The health board approved the development and implementation of a community model, based on an integrated social model for health and well-being.

“This will include clearly describing what is meant by integrated networks, moving away from the term “Hub”; enabling help and support to be accessed in a variety of ways including both face to face and virtually  and commit to concentrating on early co-design of the model in Pembrokeshire, in response to the strength of feeling expressed throughout the consultation in terms of a loss of services, with particular focus on an enhanced 24/7 community response,” it states.

The second recommendation approved was the development of a plan for the existing Community Hospitals, working with local communities. This plan will be focussed on the provision of ambulatory care including out-patient services, diagnostics, treatment, observation, rehabilitation and end of life care.

This includes developing  a “long term plan that enables the delivery of acute medicine over time to be tested and challenged, and to be responsive to demand and patient flows associated with the proposed changes.”

As well as developing a “transition plan to transfer emergency and urgent services from existing General Hospitals in a safe and sustainable phased way, dependent on the development and impact of the model and the new Urgent and Planned Care Hospital.”

Work with neighbouring health boards will be key to developing a health strategy, particularly ABMU’s clinical strategy to maximise “opportunities for effective regional pathways.”

A  range of options designed to “ensure consultant-led obstetrics, midwifery led care, acute paediatrics and neonatal care are maintained across Hywel Dda” will be looked at and there is a guarantee of complete alignment with the requirements of the Transforming Mental Health Programme.

The start of a business case for a new planned and urgent care hospital is given the go-ahead as well as consideration of location options via  feasibility study and “options appraisal to robustly consider all potential impacts.”

A detailed plan addressing significant concerns about access, travel, transport and infrastructure will be developed along with a plan to maximise the use of technology.

The case for change focusses on the need to ensure “fragile” services do not collapse due to rising demand and staffing issues.

Jeremy Williams, clinical director for unscheduled care, said increasing waiting times in both emergency and planned care would be overcome by the new model as well as reducing the need for cancellations.

Independent member David Powell wanted assurance that the changes would address the current fragility issues, highlighting a low-level of public belief that it would.

Financial issues also need to be overcome with Elaine Lorton, county director for Pembrokeshire, stating that Hywel Dda is £0.9million in excess of its planned deficit in month five of the year.

The recommendations will be developed into a draft health strategy and brought to the November meeting.

Hywel Dda Medical Director and Director of Clinical Strategy Dr Philip Kloer said: “We’re aware that some people, particularly those who live furthest from the new hospital zone between Narberth and St Clears may be anxious about these changes. They will not happen overnight and we are committed to working with those communities and our partners to demonstrate and test what additional provision can be made, particularly for time-sensitive emergency conditions.

“For example we are working with partners to build the case for the Emergency Medical Retrieval Team (doctors who are brought to the scene to treat and then transfer) and CHANTS (the Neonatal Retrieval Team) to be a 24-hour service, and also investigating the potential to place advanced paramedics in communities so they are available solely to that community.

“Another important factor in providing life-saving treatment is getting people quickly to the definitive hospital which will provide their care. At the moment, people in our coastal areas of Pembrokeshire have to travel to Glangwili for some treatment, which in the future, we will be able to offer at a more equitable location, for the south of Hywel Dda, in the new hospital zone.”

The new hospital will be dependent also on a full business case, which will be made to the Welsh Government.