Friday will be D-Day for many of our local health services. On Friday morning, the Betsi Cadwaladr University Health Board will meet to decide whether to centralise and downgrade local health services in keeping with a model that the Cardiff Labour Government are looking to impose.
The services most directly affected by this downgrading will be several community hospitals, including Llangollen and Fflint. These are just two scheduled to close with the carrot of "enhanced home care" to replace them. There has been a trial of enhanced home care in the Rhyl and Prestatyn area and it was very popular with patients. But this was only affordable in a small area from the capital receipts from the sale of the Alexandra Hospital in Rhyl. If it was to be rolled out across the region, the health board would soon be bankrupt.
The other carrot are new health centres but there is little in the consultation to explain how these would be financed. The best guess is that the Welsh Government will fund them, despite a 41% cut in its own capital budget due to UK Government spending cuts. For a health board that is already £60 million in debt, there is little prospect of finding tens of millions to build new health centres - Llangollen's alone is estimated at £5m.
So the likelihood is that patients who would have used the community hospital will be transferred to nursing homes, which are also at capacity and struggling. With a growing elderly population, upgraded community hospitals should be an essential component of the local health service - not according to this flawed model.
Before moving on to the other major problem with the proposals - the moving of neonatal intensive care to Arrowe Park in England - let's consider why Betsi Cadwaladr and Hywel Dda (in Mid and West Wales) are having to impose a metropolitan model on a largely rural area.
Back in 2007, Plaid Cymru successfully halted Labour's plans to close and centralise NHS services. It did so by winning the political argument and campaigning at grassroots level. The One Wales agreement that same year had a commitment not to close community hospitals.
Once Labour took sole control of the Assembly Government in 2011, it reverted to type and went for local health services again. This time, the Health Minister Lesley Griffiths got the health boards to do Labour's dirty work.
The huge reaction against the proposals has been most clearly articulated around the community hospitals. In Flint 2,000 people marched against the closure plans. They, like other communities across the North, have seen that their Labour AM have been deafening in their silence. The good people of Flint decided to take their message to their AM, Sandy Mewies. Watch the video and watch a politician being skewered by the people.
The other huge issue is moving neonatal intensive care from the North to Arrowe Park. This is a move opposed by clinicians in Betsi, the Royal College of Nursing, the British Medical Association as well as thousands of ordinary people. The only people seemingly in favour are a section of the health board. Why? Arrowe Park does not have a long history as a Level 3 Special Care Baby Unit, it has had some damning internal criticism and its ratio of nurses to babies compares unfavourably with both Glan Clwyd and Wrecsam.
The cost of caring for these very sick neonates under the terms of the contract drawn up between Betsi and Arrowe Park was an eye-watering £1240 a day - significantly higher than the £1024 it currently charges. The annual contract was estimated to cost £1.1m.
Such a move will probably endanger lives, cause huge hardship and stress for families with sick babies at Arrowe Park for a long period, de-skill existing staff and damage morale on the three SCBUs left in the North. The failure to recruit enough skilled doctors points to a failure of management at the highest level.
So on Friday morning we will see whether the proposals are approved. They may then be subject to a formal objection by the Community Health Council - a largely toothless watchdog. If that is the case, then the final decision rests with Wrecsam AM Lesley Griffiths, the Health Minister.