Reacting to the decision, Protect Bronglais Services, who were set up in direct response to the threat posed by the changes and handed in a 17,000 name petition against them, said the decision meant stroke provision at Bronglais is still unclear.

Chair, Lisa Francis, said: “At no point during the discussion amongst the 25 or so board members who were present there today did I hear the words ‘ambulance’ or ‘ambulance availability’ and only one person mentioned the vast Mid Wales hinterland that Bronglais serves which kind of tells you all you need to know really.

“Just how these patients will be transferred is still something of a mystery although I was assured during the interval by one of the Board’s planning team that these transfers would be undertaken by dedicated ambulance provision with supporting clinicians on board.

“According to Hywel Dda’s engagement team this ‘Merged Option Idea’ will now need further community engagement, and under statutory guidance this falls within Phase 2 of the Consultation and should take around six weeks to effect. If this ‘engagement’ process starts soon, this will almost certainly take us into the ‘purdah’ period of the forthcoming Senedd elections and so I’m not even sure it would be allowed.

“This has really muddied the waters! No-one around the table mentioned ambulances; nor did anyone mention the Senedd elections.

“Fast forward to 7 May and it’s entirely possible there will be a new Government running Wales.

“Depending on who this might be, any ‘Merger, Option, Idea’, call it what you like – (don’t even tempt me!), could very well be dropped.

“You really couldn’t make it up.

“In so far as this latest lamentable, cobbled-together amalgam is concerned, PBS is insisting that the health board go out to full public consultation – nothing else will do.

“‘Engagement’ covers a multitude of ‘do-it-yourself, mark-your-own homework’ possibilities and that’s just not good enough for the people served by Bronglais. Online meetings with various ‘stakeholders’ and no advance sight of accompanying papers springs to mind!

“The fact that this new ‘Merger Option Idea’ would require further engagement came as something of a surprise to the Board’s Chair who during the later part of the meeting insisted that the Board should now take the opportunity to work up a ‘Transport Strategy’.

“‘Cart before horse’ springs to mind.

“Personally, I’m afraid I just can’t help but wonder what exactly it is that we are paying them all to do?”

Mark Williams, Chair of the North Ceredigion Forum for Older People’s Care said: “Not for the first time the health board have ignored the overwhelmingly expressed concern of local people over transportation now to Glangwilli General Hospital.

“This may be closer than Llanelli, but fundamentally misses the point.

“Indeed transport to services miles away was barely mentioned at today’s board meeting.

“Throughout this entire process Hywel Dda have lamentably failed to reassure the public on this most basic of necessities - how are stroke victims safely to be transported between hospitals, and should this be the case at all.

“This was the message of the public meetings, the demonstrations at the Senedd and most recently the 800 strong demonstration outside Bronglais.

“The newly emerged option does not define what rehabilitation service at Bronglais will look like.

“So stroke victims will endure Treat and transfer, then be sent to Glangwilli for 72 hours, before returning to Bronglais to an undefined service, which will not be a stoke unit.

“Have the Board reflected on if a patient refuses to be transferred? How soon after clot busting drugs have been administered will the patient be transferred? What is the mortality rate during this window? These are all fundamental questions.

“The board meeting today leaves us at best confused. We want clarity, accountability and a service that responds to the needs of a vast rural area. The board are failing on all three counts.”

Ceredigion MS Elin Jones welcomed the fact that both original stroke consultation options were rejected by the health board, but also raised concerns over confusion the new option presents.

She said: “There is now considerable confusion around what may be proposed for stroke patients at Bronglais.

“Whilst Glangwili now seems likely to be the location of the board’s main Stroke Unit rather than Llanelli, it’s less certain what the Rehabilitation service proposed for Bronglais will entail. People in the Teifi Valley will be much better served by a Glanwgili Unit rather than face transfer to Llanelli.

“However, for Bronglais, the Treat and Transfer Model remains in the new proposal, and no clarity has been proposed on how a safe and dedicated model of transfer for very ill stroke patients will be guaranteed. People will also want to know what a longer-term rehabilitation service at Bronglais will look like.

“At the very least we need now to get a detailed alternative proposal from the Health Board and there needs to be a meaningful formal consultation on the new proposal. This time it also needs to have a detailed plan for how ambulance transfer would be achieved.”

Montgomeryshire MS Russell George said:”While there is a proposal for a rehabilitation service to be based at Bronglais, we don’t know what that will look like in practice, It seems the health board want to push ahead with the Treat and Transfer model, a move that will have devastating implications for patients across Mid Wales.”

Dwyfor Meirionnydd MS Mabon ap Gwynfor said: “We all agree on one thing - that we want to see the highest level of care for patients – our loved ones.

“But that care must take into account travelling distances for patients and their families, which is why developing rather than cutting services at Bronglais is crucial.

“I welcome the fact that new options are being considered, specifically looking to develop a new rehab unit at Bronglais.

“However, I’m concerned that there is so little detail about the new proposal.

“I, and the people of mid Wales, need to understand what the proposal entails before we can come to a conclusion. I will therefore be seeking further detail from the health board at the earliest possible opportunity, and this will need to go through the rigorous full consultation process as well.

“I remain steadfast in the belief that Bronglais should be developed as a centre of excellence for rural health.”

Sandra Jervis, Welsh Liberal Democrat Senedd Candidate for Ceredigion Penfro, said: “It remains a deep disappointment that Ysbyty Bronglais is being pushed towards a Treat and Transfer model, even with the prospect of a rehabilitation unit on site. “Whilst locating the 24-hour stroke unit at Glangwili Hospital is clearly more sensible than Prince Philip, it still does nothing to address the needs of patients in the north of the county and the wider rural Mid Wales catchment served by Bronglais. “The unanswered transport concerns of so many residents remain exactly that, unanswered. “To suggest there is ‘confusion’ about what Treat and Transfer means is patronising. People understand perfectly well that acute services are being centralised away from Aberystwyth. The real issue is whether rural communities are being short-changed.”