Hywel Dda chief executive said there had been “some head scratching” and a lot of hard work behind the scenes in preparation for the next steps of its 20-year plan for west Wales.

Hywel Dda University Health Board has approved its scoping, governance and delivery plan for its health and care strategy given the green light last November.

Concerns about staff capacity, transport and impact on patients were raised by members of the board at the meeting on Thursday, March 28.

As it moves into the third phase of its “large scale transformation programme” which prompted backlash from communities, particularly in Pembrokeshire, the focus is now on delivery.

Chief executive Steve Moore said it was “an exciting time to be a member of this board” while acknowledging the prepared plan will be subject to change over time.

Medical director and director of clinical strategy Phil Kloer said ‘Transforming Clinical Services’ had been a “huge piece of work and there’s a large expectation now on us to deliver.”

The work will be split into three – “Transforming our  Communities, Transforming our Hospitals and Transforming Mental Health and Learning Disabilities.”

It will also be closely linked with the Regional Partnership Board’s work.

It highlights a “move away from a traditional structural approach” said Ros Jervis, director of public health, towards a prevention and early intervention focus.

Professor John Gammon raised how effectiveness was to be determined with clarity required on how the health board assess the impact on patients and outcomes.

This would be looked at throughout delivery he was told.