Patients 'anxious' over Hywel Dda health shake-up
BBCIt has been called the start of an "ambitious 20-year journey" to transform hospitals and other healthcare across Carmarthenshire, Ceredigion and Pembrokeshire.
But while many accepted that Hywel Dda health board needs to make changes, there is anxiety about what the details will mean in practice.
Hundreds had filled in questionnaires, thousands more had signed petitions.
Campaigners gathered in Carmarthen for the health board meeting on Wednesday, where the decision was made after three and a half hours.
There was caution from the local patient watchdog, Hywel Dda community health council, whose formal response was included in the final proposal document.
It said the case for change was strong but the way forward would be complex and there were concerns from the public about accessing care.
Under the plans, there would be an end to round-the-clock A&E at Carmarthen and Haverfordwest - but a new hospital would be built in between.
The patient watchdog made 18 recommendations - including a community hub in north west Pembrokeshire.
"Until more work is done to illustrate how each component of a new system could operate more clearly, the public cannot be expected to accept change where there is concern and opposition," it said.
David Williams, a health campaigner from Milford Haven, was typical of Pembrokeshire patients on the coast worried about being further away from an A&E.
"Something needs to be done but I don't think moving services into more centralised points is the answer," he added.
But John Skipper, a cancer patient who has had treatment in Cardiff, Swansea and Carmarthen, said doing nothing was not an option. "Glangwili is not fit for purpose - you're trying to cram too much in there, you have a colorectal ward with just one shower and one bath and you have staff who are very discontented with the conditions they're working in.
"It's very much spend to save. It's not going to happen overnight, it could be five, six seven years before anything takes place, but a new hospital is a must."
Preseli Pembrokeshire MP Stephen Crabb called it "another kick in the teeth" for the people of Pembrokeshire.
"If the long-term plan is to build a new hospital then we need some cast iron commitments from Welsh Government over funding and location and a promise not to reduce any more services at Withybush until that new facility is open and functioning," he said.
Plaid Cymru politicians called the proposals "disappointing" and a "missed opportunity to genuinely transform health and social care." It called on the health secretary to intervene and properly merge health and social services.
Adam Price, Carmarthen and East Dinefwr AM, said: "The obsession with endless reconfiguration of secondary care has to stop," while Mid and West Wales AM Helen Mary Jones added: "It is clear to us that the health board's choice doesn't address how services will actually be improved in the short to medium term."
Health board chief executive Steve Moore told BBC Wales it was not about downgrading hospitals but centralising emergency care "so we can do that better".
Medical director Dr Phil Kloer said: "We're aware that some people, particularly those who live furthest from the new hospital zone between Narberth and St Clears may be anxious about these changes.
"They will not happen overnight and we are committed to working with those communities and our partners to demonstrate and test what additional provision can be made, particularly for time-sensitive emergency conditions."