Health board to consider major shake up of clinical services

Hywel Dda University Health Board is set to take a major step towards reshaping healthcare across west Wales next month, as it prepares to decide on the future model for nine key clinical services.

An extraordinary meeting of the Health Board will be held over two days on February 18 and 19, when board members will consider evidence gathered through a lengthy public consultation and a series of updated assessments.

The services under review form part of the Health Board’s Clinical Services Plan and include critical care, dermatology, emergency general surgery, endoscopy, ophthalmology, orthopaedics, stroke, radiology and urology.

Proposals for change were put out to consultation in response to what the board has described as growing fragility in the system, long waiting times and challenges in meeting modern clinical standards.

More than 4,000 people responded to the consultation through questionnaires, while a similar number attended public meetings, staff events and stakeholder sessions. Feedback from this process has now been collated into an independent report prepared by Opinion Research Services, which will form a key part of the board’s deliberations.

Mark Henwood, the Health Board’s Executive Medical Director, said the status quo was no longer sustainable.

“We know these services are fragile and cannot continue as they are,” he said. “Our clinical teams are spread across many sites, recruitment is a challenge across the NHS, and parts of our hospital estate are approaching or have reached the end of their intended life. We need to make decisions now so that services can raise standards and meet the needs of our population into the future.”

Alongside the consultation report, board members will review updated information on workforce pressures, service resilience, estate condition, operational performance and new clinical standards. An update will also be presented on how circumstances have changed since an Issues Paper was published in March 2024, which originally set out why reform was considered necessary.

A wide range of impact assessments will also be scrutinised. These include Equality Impact Assessments, examining how proposals could affect people with protected characteristics and Welsh language needs, and Quality Impact Assessments focusing on patient safety, effectiveness and experience. Health, environmental and climate impacts will be considered, alongside transport analysis for both emergency and non-emergency patient journeys and assessments covering finance, workforce and capital investment.

Criteria

Proposals will be judged against criteria including clinical sustainability, accessibility, deliverability, alignment with the Health Board’s long-term strategy and financial viability. In some cases, interim decisions may be taken where further engagement or additional evidence is required before final models are agreed.

Dr Neil Wooding, Chair of Hywel Dda University Health Board, thanked residents and staff for taking part in the consultation and said public feedback would be weighed carefully.

“The consultation report provides an important basis for discussion, but it is one of several factors we must consider,” he said. “We have a responsibility to balance public views with clinical evidence, workforce realities and sustainability challenges, while ensuring services meet the highest possible standards.”

He added that the decisions would shape services for years to come and must provide clear public value without creating unintended consequences for the future.

Lee Davies, Executive Director of Strategy and Planning, said the process was about identifying what changes could be made immediately and where further work was needed.

“Community and staff feedback helps us focus on what matters most to people, while programme assessments show what is practical and safe to deliver,” he said.

The extraordinary board meeting will be held in public and broadcast online, with papers and access details published on the Health Board’s website in advance.