Health services in mid and west Wales need certainty instead of more cuts, it has been warned, as plans to shake up services in the region will go out to consultation amid a challenging financial backdrop with a projected Hywel Dda University Health Board deficit reaching upwards of £50m.

At the 29 May meeting of the health board, members agreed to back the launching of a public consultation, running to 31 August, into the proposed changes, with many different options in each of the nine services across the area, with some hospitals gaining or losing services, along with community site options in some cases.

Hywel Dda University Health Board’s Clinical Services Plan focuses on nine healthcare services that are “fragile and in need of change,” it has said, with services, and potential changes at the four main hospitals of Haverfordwest’s Withybush, Carmarthen’s Glangwili, Llanelli’s Prince Philip and Aberystwyth’s Bronglais, which include - critical care, emergency general surgery, stroke, endoscopy, radiology, dermatology, ophthalmology, orthopaedics, and urology.

In the case of critical care, there are three options - Intensive care units kept at Bronglais and Glangwili.

An enhanced care unit would be provided at Withybush and Prince Philip.

Another enhanced care unit would also be developed at Glangwili, so the intensive care unit at Glangwili can focus on the sickest patients.

Patients at Prince Philip or Withybush needing specialist critical care would be transferred to Glangwili.

Intensive care units would be kept at Bronglais, Glangwili and Withybush.

Patients at Withybush needing surgery would be transported to Glangwili for their operation, before returning to Withybush when fit to do so to recover. Emergency general surgery consultant surgeons would be based at Bronglais, and at either Glangwili or Withybush on alternate weeks to provide surgical operations.

There is an additional need with this option for surgical cover to remain at Glangwili for children and young people (paediatrics) on weeks when the service is operating in Withybush.

The plan includes turning Bronglais’ stroke unit into a ‘Treat and Transfer’ Unit, a move that has been greeted with uproar by local politicians and residents and led to the formation of a residents’ group in a bid to put pressure on the health board to retain services at the Aberystwyth hospital.

The plan has caused great concern, with a group of Aberystwyth residents forming the Protect Bronglais Services (PBS) campaign group in a bid to secure services at the hospital.

Following the meeting where the consultation process was given the green light, Ceredigion MS Elin Jones called on the “community to work together to reject the plans.”

Ms Jones said she was “totally against the treat and transfer proposal for stroke services at Bronglais” and has made her views known to the Health Board “on numerous occasions over the past few months and also to Welsh Government Ministers.”

“I have also visited the stroke unit where I discussed our current provision with staff and patients, and I spoke at a public meeting in Aberystwyth,” she said.

“This model of care would make it virtually impossible for relatives to visit patients daily or frequently, and we know how important these visits are to aid recovery from stroke.

“We cannot accept this offer of a treat and transfer model, and I’m working with everyone in the local community in the hope that the Health Board will realise that this model is unacceptable.

“I urge everyone to respond to the public consultation when it opens, so that we can try to secure the current high-quality services we have in Bronglais, and that the Health Board receives a very clear ‘No’ from the people of Ceredigion.”

Aberystwyth Town Council said that the mooted change to the stroke unit “would strip Aberystwyth of a high-performing, life-saving service and force vulnerable stroke patients to travel long distances for care, putting lives at risk and further undermining healthcare provision in our local area.”

Montgomeryshire Senedd Member Russell George said the move could have “devastating implications for patients in mid Wales.”

Mr George said the unit “plays a critical role” in serving large parts of his constituency, and the move would mean patients could face being moved on to another hospital outside of mid Wales.

Three Powys councillors called for “lives to be put above cuts” after voicing their “huge concerns” about the threatened cuts to stroke services at Bronglais.

The three Dyfi valley Plaid Cymru councillors - Elwyn Vaughan Glantwymyn, Alwyn Evans Machynlleth and Gary Mitchell for Llanbrynmair & Trefeglwys - said the plans were of “great concern” and would “inevitably have a huge impact on residents in the Dyfi valley and Llanidloes area.”

“At present the stroke pathway facility at Bronglais is gold standard,” the councillors said in a joint statement.

“At present it feels we are losing our valuable services with everything being centralised.

“Due to the importance of Bronglais to not only Ceredigion, but a large part of Powys and South Gwynedd, we call on the Health Minister to work with us and Health Boards in having a integrated approach to health services in this area.

“The danger without acknowledging the importance of Bronglais to much of Mid Wales is that this piecemeal approach of taking services away from the area ends up with nothing left.”

Hywel Dda bosses insisted the Bronglais Hospital stroke unit downgrade proposals are not “financially driven” during a fiery public meeting in January, but last year a health board report warned that it was staring down an “unacceptable” forecast deficit of almost £80m and that cash could run out by February if savings were not realised.

The Health Board approved a budget last March with a planned deficit of £64m, delivering £32.4m in savings.

That plan, which was rejected by Welsh Government as “unacceptable”, required the health board to post a deficit of no more than £5.3m a month.

That meeting heard that the health board “will require strategic cash assistance in line with its forecast deficit and working capital balances in order to make payments from the end of February 2025 onwards.”

The latest board meeting on 29 May heard that the planned deficit had now been reduced to £31.55m but conceded that planning a deficit was a “novel and contentious action by not delivering against the Board’s statutory duty to financially breakeven across a three-year period.”

A report said: “There has been significant effort in the last quarter to fully identify the £32.4m savings target, with £32.9m being identified, of which £31.5m has been actually delivered on an in-year basis, leaving an under delivery against identified plans of £1.4m, and £0.9m adrift of the savings target set within the annual plan.

“Whilst savings delivery is an improving trend, of the £31.5m delivery projection, there is a recurrent savings shortfall of £14.3m, resulting in the underlying deficit significantly exceeding the 2024/25 outturn of £24.1m.”

The underlying deficit, however, remains above £50m coming into the 2025/26 financial year.

The longer term plan remains to balance the books by 2027/28 through a series of savings, with further plans likely to come forward over the next two to three years.

A report for the meeting on 29 May said that the health board retains its “commitment to establishing a clear route map to in-year financial balance by 2027/28, and has “the intention to develop plans to improve upon this position in quarter two, aiming for a position which is below £30m.”

Judith Paget, Director General Health and Social Services at NHS Wales, in a letter to Hywel Dda Chief Executive Phil Kloer said that while she “understands and recognises the challenging financial position of the health board, the current position is not supportable.”

Mr Kloer said the health board is “fully committed to eroding our financial deficit and agree that continuing our improvement trajectory is of paramount importance for 2025/26.”

“We have an ambitious and balanced plan, including £44m of savings,” he said.

“We will pursue further improvements beyond this and into subsequent years.”

While stroke services at Bronglais remain under threat, concerns over the Angharad children’s ward have been eased by the health board announcement that new staff had been recruited to return it to full operation.

In September, the health board announced that children requiring more than 36-hours of hospital-based care, would be transferred from Bronglais Hospital to Glangwili Hospital, Carmarthen over a six-month period.

The temporary change has ended after six new members of nursing staff were appointed.

In March, Health Secretary Jeremy Miles confirmed that Hywel Dda will be de-escalated from level four to level three for Welsh Government intervention on its improved leadership, planned care performance and improvements in its children and adolescent mental health services.

However, the health board remained at escalation level four for the emergency care performance and finance and planning, meaning a high level of NHS Executive and Welsh Government intervention in those areas.

Pembrokeshire Conservative Senedd Members, Samuel Kurtz and Paul Davies MS, said that any changes to health services in the area could have a big impact on residents, and said that removing services from Withybush hospital in Haverfordwest is “unacceptable.”

“Hywel Dda University Health Board has launched yet another consultation on the future of healthcare services in our area,” Mr Kurtz said.

“They’ve now labelled nine key services as “critical” - including emergency general surgery, stroke, and radiology, raising fresh concerns that even more of Withybush’s services could be stripped away.

“This is unacceptable and it is a consequence of a policy of centralisation of services brought forward by the Welsh Government over a number of years. The people of Pembrokeshire should not be forced to travel further for vital treatment.

“We’ve already seen the damaging loss of services like SCBU, consultant-led maternity, and children’s A&E. Each cut chips away at the hospital’s viability.

“Let me be absolutely clear: if the viability of A&E is threatened, that would be a red line, one I will not allow to be crossed. Withybush doesn’t need more cuts. It needs support. Investment. Certainty.

“Paul and I will continue to stand shoulder to shoulder with our community in defending the services this hospital, its staff and the people deserve,” he added.

Mr Davies, a longstanding campaigner against the downgrading of services at Withybush Hospital, said: “This consultation is the latest in a long line of consultations that have all resulted in vital services being cut at Withybush hospital – and enough is enough.

“It is not acceptable for the people of Pembrokeshire to have to travel further for vital health services and I will be fiercely campaigning against Hywel Dda University Health Board’s latest proposals.”

“Withybush hospital has been under attack for years because of the Health Board’s ideological pursuit of a shiny new hospital elsewhere in west Wales. Withybush hospital and the people it serves deserve support and investment, not more cuts.

“The Welsh Government should intervene and ensure that services stay put at Withybush hospital.”

Hywel Dda Medical Director Mr Mark Henwood said: “No decisions have been made on the options presented, and there are currently no preferred solutions.

“The changes we are looking to make are to ensure we have safe, high-quality services and affordable healthcare in the future, and have at their heart the best interests of the people of west Wales and their patient experience.”

Mr Henwood said the reasons for the changes include difficulties in staffing services across all hospitals and the challenge of getting back to the same levels of treatments that were being delivered before the Covid pandemic.

He said that “no staff will lose their jobs during this process.”

“This is not about saving money,” he added.

“This is about delivering the highest quality care to our patients."

The consultation on service changes launched on 2 June and will run until 31 August.

The Health Board said it “will consider what they have heard in consultation, as well as supporting evidence and data.”

The results of the consultation are due to be discussed at the Health Board meeting in November.