We write today to give the response of Aberystwyth Town Council to the Hywel Dda University Health Board (the Health Board) Clinical Services Plan Consultation.
Aberystwyth Town Council welcomes the opportunity to comment on the Health Board’s Clinical Services Plan. As the principal acute hospital for mid and north Ceredigion (with catchments into south Gwynedd and north Powys), Bronglais General Hospital (BGH) is a strategic asset for an extensive, rural and often hard-to-reach population. Any change to core services at Bronglais General Hospital has significant clinical, cultural, and socioeconomic implications for our town and the wider region.
The Town Council appreciates that the Health Board faces budgetary challenges compounded by the large and rural nature of the area, and acknowledges these are a considerable factor in any ongoing plan. We would also note a general north/south split in a whole variety of factors, especially transport provision and accessibility across Ceredigion, north Carmarthenshire, and north Pembrokeshire compared to south Pembrokeshire, south Carmarthenshire, and Llanelli. This north/south split is compounded by the rural/urban split also seen across the Health Board’s area, which has affected service provision, availability, staffing, and a whole other set of factors driving decisions in the Clinical Services Plan.
Strategic importance of Bronglais General Hospital
Given long, weather-sensitive road journeys to alternatives (Carmarthen, Haverfordwest, Bangor), Bronglais General Hospital (BGH) must retain a full District General Hospital profile, including 24/7 emergency department, acute medicine and surgery, paediatrics, obstetrics, critical care, and time-critical pathways (stroke, cardiac, sepsis, major trauma stabilization and transfer). Any downgrading would embed health inequality and wider inequalities, due to factors such as travel time, cost and availability of public transport for patients and families, accessibility, and language.
Summary of preference
The Town Council therefore welcomes the options proposed for Critical Care, Emergency General Surgery, Orthopaedics, and Urology, as there are no options that negatively impact BGH.
The Town Council regrets all options presented for Endoscopy, as they will all negatively affect BGH, but requests further work in this field to designate any community site to be located in the north of the Health Board’s area.
The Town Council has a preference for:
- Option C proposed for Ophthalmology, especially considering the regional work undertaken with Swansea Bay University Health Board, which means that maintenance of service provision in the north of the Health Board area is essential.
- Option C proposed for Radiology, as this means a maintenance of the service level at BGH.
The Town Council strongly opposes all options relating to Stroke services, and requests the Health Board to designate Bronglais General Hospital as both the health board and the region’s “Centre of Excellence” for Stroke Services, making it the hub of delivery for patients who are unable to be transferred out of the Health Board area (which may be the case for patients closer to Swansea Bay University Health Board or Betsi Cadwaladr University Health Board). Regional working with Swansea Bay University Health Board could then be utilised to designate a wider regional hub of excellence for stroke care in the Swansea Bay University Health Board area, with patients and support networks being able to utilise the comparatively stronger transport networks of the south, unavailable as an option in the north of the Hywel Dda University Health Board area.
Stroke services
Stroke care is uniquely sensitive to distance and delay. The Council is deeply concerned about the proposed “Treat and Transfer” model.
The proposed model of treat and transfer is mostly advocated due to the clinical research. Aberystwyth Town Council has however, in the course of its reading, identified a research gap. In the research, there’s good evidence of rural outcome gaps and good evidence that social support influences recovery, but little to no work on the effect one may have on the other. What is clear however is that there are rural-urban outcome gaps, and that social support networks have a positive influence on recovery. Patients from across north, mid, and west Wales (serviced by BGH) will be more socially isolated under a treat and transfer model, and that social isolation will lead to worse outcomes overall.
We believe it is essential to maintain a full stroke service at Bronglais General Hospital, fully capable of both acute care and ongoing support of patients in the long term. Onsite rehabilitation must be retained, with stroke unit beds and wider professional health coverage, to prevent avoidable deterioration and prolonged hospital stays. The Council cannot support a “downgrade” to acute services, clinics, or outpatient services in the north, as this would be unsafe in a region where ambulance response and retrieval times are inherently unpredictable, and resources are lacking.
Should reconfiguration proceed in any form, a set of minimum standards must be guaranteed. These should include published response times for key stages of stroke care, transport protocols with ambulance capacity modelled against real rural travel times and resourcing, and a full equity audit to monitor outcomes such as thrombolysis rates, time-to-treatment, complications, survival, and long term outcomes. Without such safeguards, changes to stroke services risk worsening outcomes and deepening existing health inequalities.
The Town Council also supports the submission made by the “Protect Bronglais Services” group in this regard.
Impact on the Welsh language
Aberystwyth, Ceredigion, and the wider Meirionnydd and North Powys area have a high proportion of Welsh speakers. Safe, person-centred care requires patients — especially vulnerable patients; those with cognitive impairment, stroke, or mental health needs — to receive services in their first and chosen language.
The Council expects the Health Board to uphold the principles of the Welsh Language (Wales) Measure 2011 and the Welsh Language Standards by ensuring that Bronglais General Hospital can always provide an “active offer” of Welsh-medium care. This includes triage, assessment, consent, therapy, and discharge planning, both in-person and via digital services. Welsh-speaking cover should be available across every ward and within the emergency department, with particular attention paid to the needs of stroke patients, where access to Welsh-medium speech and language therapy is critical to rehabilitation.
We request that the Health Board publish site-level data on Welsh-language provision, including the percentage of patient interactions delivered in Welsh, staff Welsh-language competencies, and patient-reported experience measures, collected bilingually. Recruitment strategies must explicitly promote Welsh-language skills, offering incentives, career progression, and training opportunities for Welsh-speaking staff. Without such action, any shift in services away from Bronglais General Hospital risks weakening access to care in Welsh and thereby undermining both patient safety, dignity, and outcomes.
Bronglais General Hospital as a major local employer and key institution
Bronglais General Hospital is one of Aberystwyth’s largest employers and plays a central role in sustaining the local economy. Any decision that reduces onsite services or training activity risks significant economic consequences, including direct job losses, contraction in local supply chains, and knock-on effects on families, housing, schools, and the town’s economy.
The Council therefore calls for a full economic impact assessment of any proposed changes to services at BGH, taking into account not only direct employment but also the wider multiplier effects on the community. The hospital must be developed as a training and research hub, in partnership with Aberystwyth University and further education providers, to build sustainable workforce pipelines across clinical, allied health, scientific, digital, and apprenticeship pathways. Certainty around capital investment must be provided through clear timetables and ring-fenced budgets to strengthen staff morale and secure recruitment. While digital and remote healthcare models can complement local provision, they must never be used as justification for reducing employment or relocating posts away from Aberystwyth.
Transport and accessibility
Given limited public transport and long inter-hospital transfer times, services must remain as local as clinically safe. Where changes are unavoidable, the Health Board must evidence ambulance and non-emergency transport capacity to meet time-critical targets and support families and carers in visiting patients. Where financial or logistical hardship arises from long-distance travel, mitigation measures should be in place to ensure equitable access to care.
The Health Board should consider staff, patient, and patient support networks’ travel times and accessibility in any plan going forward.
Community care and integration
The Council wishes to recognise the progress that the Health Board has made in embedding community-based care and integrating health and social services more effectively. The expansion of primary care clusters, the increased use of community nursing teams, and the development of new models of care closer to home have all contributed to improving access for patients and reducing unnecessary hospital admissions.
We particularly welcome efforts to strengthen preventative care and early intervention, which are vital for addressing the needs of an ageing population in rural areas. The emphasis on supporting people to remain in their own homes and communities wherever possible is both compassionate and cost-effective, and the Health Board is to be commended for this direction of travel.
However, while community care is rightly being developed and expanded, it must complement — not replace — the acute and emergency services provided by Bronglais General Hospital. A well-functioning healthcare system requires both local community support and the safety net of a fully resourced District General Hospital. We therefore encourage the Health Board to continue building on its community care successes while ensuring that Bronglais General Hospital remains a strong and central pillar in the wider care pathway.
The role of Welsh Government in decisions affecting Bronglais General Hospital
Aberystwyth Town Council believes that changes to Bronglais General Hospital cannot be treated solely as a local issue for Hywel Dda University health Board. The hospital’s catchment extends well beyond the Health Board’s boundaries, serving parts of Powys and Gwynedd, and providing services to patients who would otherwise face unsafe distances to care. For this reason, we consider that any material reduction or reconfiguration of services at BGH requires the involvement and scrutiny of the Welsh Government.
We urge the Minister for Health and Social Services to treat Bronglais General Hospital as a strategic national asset for rural Wales, and not merely as one of several district general hospitals within Hywel Dda University Health Board. National oversight is necessary to ensure that equity of access, rural health needs, and Welsh-medium care are given full weight in decision-making. This must include consideration of transport infrastructure, workforce planning, and capital investment, all of which lie beyond the competence of a single Health Board.
Accordingly, the Council requests that any substantive service change at Bronglais General Hospital be escalated to the Welsh Government for approval, accompanied by a clear statement on how the decision supports the health, language, and economic well-being of mid Wales as a whole.
Conclusion
Aberystwyth Town Council supports clinically led modernisation that improves outcomes and equity. For our rural communities, that means strengthening – not diminishing – service provision of Bronglais General Hospital. Stroke care must remain rapid, local, and language-appropriate; Welsh-medium provision must be guaranteed in practice; community care must complement, not replace, acute hospital care; and Bronglais General Hospital’s role as a centre of excellent service across various clinical areas must be protected and enhanced.
We urge Hywel Dda University Health Board, in partnership with the Welsh Government, to safeguard Bronglais General Hospital as a fully functioning General Hospital and to invest in its future as a cornerstone of healthcare provision in mid Wales and beyond.
We thank you for taking the time to consider our response, and look forward to hearing further.
Yours Sincerely,
Aberystwyth Town Council