With the news today (August 15) that Hywel Dda has declared an internal ‘major incident’ at Withybush Hospital with three wards needing to close and patients relocated to other health board locations - as the Health Board seeks to identify the scale and impact of the Reinforced Autoclaved Aerated Concrete (RAAC) found in the building - what now for the future of the troubled Pembrokeshire facility?

The health board has decided today to declare an internal major incident in relation to RAAC at Withybush Hospital to enable it to stand up its command and control structures.

In doing so, the health board is also able to prioritise the work of its teams to deal with the emerging issue and draw upon support from partner agencies that are members of the Dyfed Powys Local Resilience Forum.

RAAC is a material that was commonly used in the construction of buildings between the 1960s and 1990s. Its presence has been confirmed at Withybush hospital and at a limited part of Bronglais hospital. It has also been identified at a range of NHS properties across the UK, including several properties in Wales.

The health board is working with a Welsh Government approved external contractor to identify the scale of the issue – this involves surveying each of the RAAC planks on site. Where structural issues are identified, the extent of the remedial work is also being assessed.

At the end of July, Hywel Dda Health Board released a statement to say that work was continuing on a programme of surveys at Withybush to determine the condition of concrete roof planks in wards at the hospital site in Haverfordwest.

The surveys, which began in May 2023, are aimed at managing the risks around reinforced autoclaved aerated concrete (RAAC) planks and are expected to continue for at least another seven months.

RAAC is a material that was commonly used in construction in buildings between the 1960s and 1990s. Its presence has been confirmed in a range of National Health Service properties across the United Kingdom and includes several properties in Wales.

Hywel Dda University Health Board’s Director of Operations, Andrew Carruthers, said at the time: “In response to Welsh Government and wider industry alerts on this product, we have put in place a range of measures to manage the risk.

“In May 2023 we appointed a structural engineering company to undertake further intensive surveys of the areas in question and provide a full report on each individual RAAC plank.”

Hywel Dda Health Board said that survey work was being undertaken at pace and was likely to continue for several months, with the work including a visual survey of affected areas, before a plank-by-plank detailed survey.

Where structural issues are identified, the extent of the remedial work was also being assessed, said Hywel Dda, which may see more local mitigations put in place, including structural props and temporary closure of impacted areas.

Mr Carruthers continued: “Survey and repair work will have an impact on clinical areas and hospital wards so all arrangements for repair work are being supported by the clinical hospital managers.”

Plans were put in place at the beginning of the survey process to manage the impact on the operation of day-to-day services at the hospital with the availability of hospital beds a priority.

The order of surveys and associated remedial works have been arranged to make the most of clinical capacity to ensure both routine and emergency surgery can continue with minimal disruption to patient care.

To make up for the temporary loss of beds at Withybush, 14 additional beds were made available in Cleddau Ward at South Pembrokeshire Hospital in Pembroke Dock.

“Our hospital and community teams are working closely together to provide effective alternatives to the reduced capacity at Withybush, ensuring our patients are cared for in a place that best suits their needs, and this includes more beds and treatments in our community hospitals,” explained Mr Carruthers.

“This in turn has enabled us to treat more patients who have required hospital care and reduce the time they stay in hospital.”

Hywel Dda said that teams were implementing plans for the next phase of the surveys on the remaining wards and offices on the ground floor at Withybush, which included a visual inspection of planks in the first instance, which will identify any areas of concern.

Mr Carruthers continued: “We know that the survey work can cause considerable disruption and I would like to thank hospital staff, patients and visitors for their patience and understanding while we are carrying out this essential work.”

Plans to downgrade the Pembrokeshire hospital and remove its A&E department, saw protests take place outside the facility last year, with campaigners wanting to see services retained.

The A&E units at both Withybush and Carmarthen's Glangwili Hospital could shut if plans go-ahead by Hywel Dda University Health Board's to build an urgent and planned care hospital between Whitland and St Clears, which would leave Pembrokeshire without a general hospital.

Both Withybush and Glangwili facilities would become community hospitals, with a focus on "patients who do not need to be in an acute setting but need support".

Campaigners fear the extra travel time from parts of Pembrokeshire could cost lives.

Health board chief executive Steve Moore said that a new hospital was vital, stating: “We are stretched very thin at the moment, and that means we struggle with staffing," he said. Quite often, people struggle with waiting times.

“While they may be able to get to the hospital front door, it can be a real challenge for our staff to see them in a reasonable timescale, and that creates a poor service for the public.

“Building a new hospital will allow us to do much better at that.”

Consultations were launched in March by the Health Board on proposals to build a new planned and urgent care hospital between Whitland and St Clears, which would leave Pembrokeshire without a general hospital.

Local politicians and county councillors have voiced their concerns over the proposals, including MP for Preseli Pembrokeshire Stephen Crabb, who stated: “The Health Board submitted ambitious plans to the Welsh Government in the hope of securing in the region of £1.3billion investment into health and care in mid and west Wales.

“Whilst the narrative from the Health Board is compelling about how this money will be used to bring as much care as possible closer to people’s homes, with plans for a network of integrated health and care centres, designed with local communities, across Carmarthenshire, Ceredigion, and Pembrokeshire, I remain concerned that at the end of the day, it leaves Pembrokeshire without a general hospital and without an emergency and urgent care department.”

Hywel Dda UHB Chief Executive, Steve Moore said at the launch of the consultation: “We do not have a preferred site and we have not bought any site or land for this development.

“Purchasing a site and delivering the new Urgent and Planned Care Hospital is subject to the Welsh Government funding, which is not yet confirmed, and if successful, would take several years to achieve.

“In the meantime, we want to continue to work with you, our communities, to prepare and deliver the best health and care services that we can.”

The three potential sites are within a small geographical area in the south of the Hywel Dda area, within the county of Carmarthenshire and near to the Pembrokeshire border.

Two are near the town of Whitland and one near St Clears, as follows:

• Whitland Spring Gardens (formerly site 12) is a short distance north-east of the centre of Whitland. It is between the A40 to the north, Whitland rugby pitch to the east, and Spring Garden homes to the south.

• Whitland Tŷ Newydd (formerly site C) is part of Tŷ Newydd Farm. The site is to the east of the old Whitland creamery. The town centre and the A40 road is less than one mile to the north of the site.

• St Clears (formerly site 17) is land at old Bryncaerau fields, next to the junction of the A40 and A477 in St Clears. The A4066 Tenby Road is to the south, the village of Pwll Trap to the north, and the A40 to the west.

Hywel Dda has stated that the overall geographical zone for the new hospital - between Narberth and St Clears – was agreed because it is the area that would mean most of our population is within an hour of an emergency department (either at this hospital, Bronglais Hospital, in Aberystwyth, or Morriston Hospital, in Swansea).

On today's announcement, a spokseperson for Hywel Dda Health Board said: “Plans were put in place in May 2023, at the start of the survey process, to manage the impact on the operation of day-to-day services at the hospital and prioritise the availability of hospital beds.

“However, as they survey progresses the scale of the issues identified is putting additional pressure on the availability of clinical space and is likely to have a knock-on impact on services.

“To date, three wards in Withybush have needed to close due to the condition of the RAAC planks found, with the situation being managed and patients relocated to other health board locations in Pembrokeshire.

“Our intention is to manage as much of the relocation of patients within Pembrokeshire as possible.

“While best efforts are being made to conduct survey work as quickly as possible, the resulting findings of the survey work is, in some cases, requiring patients to be moved from wards to alternative locations and adapting services to reflect the availability of the site.

“As time progresses, this is likely to have an impact on other health board services at other sites as we move patients and services to alternate locations.

“Local mitigations are also being put in place, including structural props and temporary closure of impacted areas.

“Unless notified otherwise, patients should continue to attend their appointments and access services at Withybush Hospital as usual. However, this may be subject to change at short notice.

“Wherever possible, patients will be communicated with directly should a change be made to the service or clinic they are due to attend.

“Further information will be made available on the health board website at hduhb.nhs.wales/RAAC

“We know that the survey work and remedial action can cause considerable disruption and concern amongst members of our community and we apologise for any inconvenience caused.

“The health board would like to thank hospital staff, patients and visitors for their patience and understanding over the coming months while we carry out this essential work.”