The accident and emergency department at the Royal Glamorgan Hospital could close as part of plans by the health board to reduce services.
Cwm Taf Morgannwg University Health Board has confirmed it will consult on four possible scenarios for the future of the Llantrisant-based hospital.
It follows major concerns over staffing levels which have become so low that the consultant-led service may no longer be safe or sustainable to run.
The four options are:
- Removing A&E at the Royal Glamorgan and turning it into a 24-hour minor injuries unit;
- Removing A&E at the Royal Glamorgan and turning it into a 24-hour (enhanced) minor injuries unit, with enhanced community and primary care;
- Retaining the status quo;
- Retaining a consultant-led department during daytime hours.
It is understood their two preferred options are to make the Royal Glamorgan a minor injuries unit with enhanced community services, while the other is to have doctor-led services for a set amount of time in the day (for example 8am to 8pm).
After that time, serious incidents would be directed or referred to A&E departments at Prince Charles Hospital in Merthyr Tydfil, Princess of Wales in Bridgend or the University Hospital of Wales in Cardiff.
Dr Sharon Hopkins, interim CEO at Cwm Taf Morgannwg UHB, said: "Staff across the health board have worked exceptionally hard to continue to deliver consultant-led 24 hour emergency services and inpatient paediatric services from the Royal Glamorgan Hospital, as well as the Princess of Wales and Prince Charles Hospitals.
"However, continuing and growing service and staffing pressures have meant that this situation is becoming increasingly unsustainable, and safe services in their current configuration cannot be maintained beyond the immediate short term without unacceptable risks to patient safety.
"We will be working closely with staff, the public and all key partners to ensure they are fully engaged in developing our future model of care and working through all implications to ensure quality is central and strengthening community based services at every opportunity."
There are major concerns that stripping the hospital of its A&E provision will have a disastrous impact on patients in some parts of Rhondda Cynon Taf, such as the Rhondda Valleys where journey times to other hospitals are substantial.
Rhondda AM and former Plaid Cymru leader Leanne Wood, who was at the health board's meeting in Abercynon on Friday morning, said: "During the meeting I expressed my anger at the current situation.
"Poor workforce planning means Wales has one of the lowest doctor to population ratios in Europe. We have one consultant for every 15,000 people here, when the UK average is around 7,000 people per consultant.
"How will people at the northernmost tops of our communities reach hospitals in good time during serious emergencies, especially with our low car ownership numbers?"
It is understood that the one remaining consultant in A&E at the Royal Glamorgan Hospital will be leaving at the end of March, meaning consultant services will be provided entirely by locums from April onwards.
In comparison, the Princess of Wales Hospital in Bridgend has eight consultants in A&E, while Prince Charles Hospital in Merthyr has the equivalent of four-and-a-half.
On Christmas Day and Boxing Day 2019, due to the sickness of middle-grade emergency department doctors, the Royal Glamorgan A&E was not able to maintain normal medical staffing levels and had to divert seriously ill patients to other hospitals.
RCT Council leader Andrew Morgan, Vikki Howells AM and Beth Winter MP also expressed concerns at the current lack of available consultants at the hospital.
They stated: "We are aware that there is a general concern within the health board that in spite of the continuous efforts to recruit consultants for A&E services at the Royal Glamorgan Hospital, there is an over-reliance on locum consultants.
"We were also informed that the last permanent consultant at the hospital is shortly due to retire and we are clear that there needs to be an urgent review into how services operate in the future.
"It must be made clear that this is not a funding issue, but that there is simply a lack of consultants - not just in the Cwm Taf Morgannwg Health Board area or even across Wales, but across the UK as a whole.
"As politicians, we fully recognise the difficulties facing the health board and we have been assured that Cwm Taf Morgannwg will be looking at different models of provision across the footprint."
In a joint statement, Alex Davies-Jones MP and Mick Antoniw AM said they would oppose any "dilution" of A&E services at the Royal Glamorgan.
They said: "Robust A&E provision at the Royal Glamorgan is a critical component of health service provision to people in Pontypridd and the wider valleys communities, and we are strongly opposed to any reconfiguration that results in a material dilution of A&E services at the Royal Glamorgan.
"Any proposal must also have patient safety as its fundamental principle. We will express these views forcefully to Cwm Taf Morgannwg Health Board, Welsh Government and others during the consultation."
The Royal Glamorgan Hospital, along with Prince Charles in Merthyr Tydfil, have been under the spotlight over the past year after a major report identified major failings in their maternity services.
A review by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives unearthed catastrophic problems in the care offered to mother and babies, some of whom died.
However, an independent panel set up by Health Minister Vaughan Gething to oversee improvements in maternity has found that encouraging signs of progress are now being made during their last review between October and December 2019.
Plans to concentrate certain services at fewer hospital sites has been slowly implemented since 2014 when the South Wales Programme was first created.
In March 2019, consultant-led maternity services were taken away from the Royal Glamorgan and concentrated at the newly-renovated Prince Charles Hospital.
Instead, £6m has been ploughed into the Royal Glamorgan to build a diagnostic hub, a new 50-bed acute medicine unit and the £7.25m Y Bwthyn NGS Macmillan Specialist Palliative Care Unit.
A health board meeting to discuss the plans will take place on January 30.