Plans for a massive reorganisation of hospitals serving a million people across mid and west Wales have been unveiled by health officials. One of the most controversial proposals would see the closure of both Withybush Hospital in Haverfordwest and West Wales General in Carmarthen.
Both would make way for a new "super hospital" based between the towns.
Some specialist acute care would also move from Bronglais in Aberystwyth and Prince Philip Hospital in Llanelli.
A three-month consultation period into the review's proposals will start on 3 April.
Early reaction from health watchdogs said the review lacked "meaningful and significant detail."
They were also concerned patients would face travelling greater distances
The review - which is by a team across all local health boards and trusts - also affects the future of hospitals in Swansea, with the intention of creating one hospital to replace services currently provided at Morriston and Singleton Hospitals.
Services in the Neath-Port Talbot and Bridgend areas would remain largely unchanged, whilst patients in Powys would continue to receive care from a mixture of hospitals in south and west Wales, and across the border in England.
The proposals are for change over the next 10 years, although the report urges a need to make decisions in the next 12 months.
The largest change would come in the old Dyfed county area, which currently has four large hospitals in Llanelli, Carmarthen, Haverfordwest and Aberystwyth.
The review board wants to move towards one overall hospital network, with specialist care centralised on a single site.
This would happen in one of two ways.
The first would make Carmarthen the main acute district general hospital site - which would take over responsibility for specialist care, such as complex and emergency surgery.
 Some acute services could move from Aberystwyth |
Withybush and Bronglais would be "networked" district hospitals, which would deal with routine care, but may not have a consultant in every field.
Llanelli would function as a local general hospital, becoming a centre for elective surgery.
The second way would be to replace both Carmarthen and Haverfordwest's hospitals with a new acute hospital for south Dyfed, at a location between the two towns.
It would be networked to Bronglais Hospital, with Prince Philip again becoming a local general hospital.
The review team have been assured that finance for a new hospital would be made available, pending a business plan.
The other big change is managerial, with one trust taking over the role of the three current ones in Pembrokeshire, Ceredigion and Carmarthenshire.
 |  I think it's going to be very difficult for people to accept this idea without a clear idea of what's to be put in its place |
The local health boards would be encouraged to work together more closely, while there would also be more community-based and GP health care.
Andrew Dearden, chairman of the Welsh GP's committee of the British Medical Association, told BBC Wales the plans had "high managerial input but seemed occasionally to be very light on looking at the effects it may have on patients".
He said: "GPs and doctors in the area are quite concerned that these things haven't been raised with them before these papers have been released."
Mid and West Wales AM Helen Mary Jones, Plaid Cymru's assembly health spokeswoman, said: "I think it's going to be very difficult for people to accept this idea without a clear idea of what's to be put in its place.
"We are talking about a big district hospital for Swansea and if for example it makes it easier to maintain some of the specialist services that we have been losing, then that might be welcomed.
However she added: "This is very much a centralising agenda, an urbanizing, metropolitan English agenda model being taken out and imposed on communities across Wales where the geography is just not going to work."
SWANSEA
The changes in Swansea are also likely to be controversial, although the plans to combine the work of Morriston and Singleton hospitals have already been mooted.
A new hospital - potentially built on a new site - could take over the work of the two current acute hospitals, and continue to offer specialised care for patients from across mid and west Wales.
BRO MORGANNWG
The changes continue in line with those introduced at the Princess of Wales Hospital in Bridgend, and the Neath Port Talbot Hospital - which operate as one unit across two sites. Bridgend would concentrate on more acute care, whilst NPT would specialise in providing elective surgery.
POWYS
The county currently does not have a district general hospital but uses services from across the region.
This would continue but patients will be affected by changes proposed in Carmarthen, Swansea and Aberystwyth.
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