We encourage you to complete the questionnaire online where possible. The deadline to tell us what you think, so your opinions can be included in the consultation, is 10 January 2027. You can do this by:
To help with accessibility you can also read the consultation questionnaire below.
Powys Teaching Health Board (PTHB) is proposing changes to adult physical and mental health community services, and urgent care and diagnostic services for adults and children in Powys.
PTHB is keen to hear feedback from all stakeholders. Before answering this questionnaire, please read the consultation document that accompanies it at Better Together, or you can request a copy by emailing powys.bettertogether@wales.nhs.uk or calling 01874 442917.
In this consultation, PTHB wants you to tell them:
• Your views on their vision and case for change.
• Which options you think best achieve the vision and respond to the case for change.
• Any views you have on the options, including the impacts you think they may have, or any concerns.
• Anything else PTHB should consider, including any alternative ideas you may have.
The main consultation issues are summarised within this questionnaire to help you answer the questions. You can access the full consultation document, and more detailed information, supporting data and analysis at Better Together. The consultation document also includes a glossary of terms used in the questionnaire.
Please complete the questionnaire online at Better Together or return this paper version to the FREEPOST address at the bottom of the questionnaire, by 10 January 2027.
Completed questionnaires will be processed by Opinion Research Services (ORS), an independent research company appointed to manage consultation responses on behalf of PTHB. All personal information will be kept securely in accordance with latest data protection laws and will be destroyed no more than one year after any decisions have been finalised.
In the reports, feedback from individuals will be completely anonymous, but views from organisations or people acting in their official capacity may be attributed. ORS may use automated AI solutions with human oversight to assist in the analysis of responses to the open-ended text questions, and therefore you should ensure that you do not include any identifying information in these answers. For further information, please see pthb.nhs.wales/privacy and www.ors.org.uk/privacy.
Which of the following apply to you? (please tick all that apply)
PTHB’s ‘Better Together’ programme is seeking to develop a plan that will better meet the needs of Powys communities in the future. The feedback PTHB has received indicates that people want earlier intervention, stronger community services, and more support at home.
PTHB’s vision is to create a health service that supports people to remain healthy and independent for longer, provides care closer to home wherever possible, and ensures that specialist care is available when it is needed. The proposed future model also aims to strengthen joined up working across physical health and mental health services. The goals are to:
To what extent do you agree or disagree with the Health Board’s vision? (please tick one box only)
If you would like to share further comments on the vision, please use the “Other Comments” section later in this questionnaire.
Please read the relevant section of the consultation document
The services provided by PTHB face significant challenges:
The way PTHB tackles these challenges must take account of the unique nature of Powys and the health facilities in the county:
To what extent do you agree or disagree that PTHB needs to make changes to respond to these challenges? (please tick one box only)
If you would like to share further comments on the case for change, please use the “Other Comments” section later in this questionnaire.
As a result of these challenges, and to help achieve its vision, PTHB has developed proposals that affect the following service areas: adult physical health services, adult mental health services, urgent care (including minor injuries) and diagnostics (such as x-ray).
The sections below briefly describe the existing service provision, before explaining the proposed changes to the model of care, and introducing the specific options. For more information, please see the consultation document at pthb.nhs.wales/BetterTogether.
Other options were discounted based on not meeting criteria such as quality and safety, access, workforce issues, affordability, or being less likely to deliver the level of change PTHB believes is required. If you wish to read more about these other options and the reasons why they were not taken further, please visit Better Together.
Please read the relevant section of the consultation document
PTHB currently operates a network of community hospitals and community-based services across the county. These facilities provide a range of functions, including rehabilitation, step-up and step-down care, recovery support and inpatient care for people who do not require treatment in a District General Hospital.
Alongside community teams providing care in people's homes and local communities, PTHB provides 146 inpatient beds across the county. Current inpatient services for adult physical health in Powys include Brecon (Epynt Ward, Y Bannau Ward), Bronllys (Llewelyn Ward), Llandrindod Wells (Claerwen Ward), Llanidloes (Graham Davies Ward), Machynlleth (Twymyn Ward), Newtown (Brynheulog Ward), Welshpool (Maldwyn Ward) and Ystradgynlais (Adelina Patti Ward). Additionally, reablement beds are located at Knighton Hospital and Glan Irfon Integrated Health and Care Centre in Builth Wells.
Demand for physical health care continues to rise, and too many people are being admitted to hospital for reasons that could be prevented if different services were available in the home; and too many people spend too long in hospital, which can lead to physical decline due to inactivity.
The proposed model of care is based on the principle that people should receive care at home wherever possible, while ensuring that inpatient services remain available in Powys when they are needed. Improvements to community services would allow more people’s needs to be met at home, reducing the need for hospital admissions in Powys or outside the county.
Specifically, the proposed model seeks to:
PTHB believes that more people could receive better health care in the right location through investment in providing more services at home. This includes Urgent Community Support for rapid assessment; and Hospital at Home for hospital-level treatment.
To enable the above benefits, PTHB proposes that community hospital inpatient care should be consolidated, and in future operate from two or three hospital sites with enhanced inpatient units. These would offer treatments that are not consistently available in Powys now, such as intravenous (IV) therapy and nasogastric nutrition (i.e. feeding a person through a small tube in their nose).
PTHB believes that current community hospitals are too small to ensure the right mix of staff with the right skills, and that better care could be offered if beds were provided on fewer sites. This, it is felt, would offer more opportunities to develop and maintain staff skills, allowing more care to be provided within the county, and fewer patients needing to be treated in a District General Hospital outside Powys.
PTHB believes that the proposed model should also offer a more joined-up approach to physical health and mental health, particularly for people with frailty, dementia and complex long-term conditions.
To what extent do you agree or disagree with the proposed model of care for adult physical health services? (please tick one option only)
Two options have been identified for physical health inpatient care.
Both options include strengthened community services in people’s homes with a greater focus on preventative health; expanded district nursing, rehabilitation, reablement, falls prevention and Hospital at Home support; and improved integration between physical and mental health services (e.g. to better support people with dementia who also have physical health needs). They would also support service quality and workforce sustainability; aim to reduce the need for patients to be cared for in District General Hospitals outside the county; and allow people to be supported more effectively at home.
Under both options, inpatient beds for patients with physical health needs would close in Bronllys, Llanidloes, Machynlleth, Welshpool and Ystradgynlais Community Hospitals. Glan Irfon Integrated Health and Care Centre and Cottage View at Knighton Hospital would continue to provide residential care.
The key difference between the options is that Option 2 would provide more services in people’s homes than Option 1, whilst Option 1 would have more inpatient sites and beds. Option 2 is more affordable than Option 1. However, Option 2 is dependent on the Health Board being able to deliver a greater level of care in the home than Option 1; and as there would no longer be inpatient beds in Llandrindod, more patients in mid-Powys would have longer journeys to access an inpatient site.
If adult physical care inpatient services were to be provided on fewer sites, which of the following options do you believe best achieves the vision and responds to the case for change? (please tick one option only)
If there are any additional comments you would like to make about the proposals for adult physical health services, please write these below. These might include:
Please read the relevant section of the consultation document
Urgent health care services help adults and children who need same-day assessment, treatment or advice but whose condition is not life-threatening. Urgent care services in Powys are delivered through General Practice, NHS 111 Wales, GP Out of Hours, community pharmacy, optometry, dentistry, participating GP minor injury services and four Minor Injury Units (MIUs) in Brecon, Llandrindod Wells, Welshpool and Ystradgynlais.
Demand for urgent care continues to rise as people are living longer, often with more complex health needs. At the same time, health services face significant workforce pressures and increasing difficulty recruiting staff with specialist skills. The availability of diagnostic services also varies across the county and does not match urgent care services’ opening hours as well as it could.
The proposed model of care aims to ensure that people receive the right care, in the right place, at the right time. The focus is on improving access to urgent assessment and treatment, reducing avoidable attendances at emergency departments outside the county, and supporting stronger links between urgent care, community services and hospital services.
Specifically, the proposed model seeks to:
PTHB therefore proposes that MIUs and diagnostic services should be consolidated and operate from two or three hospital sites in future, so they can be upgraded to UCCs or to MIIUs to deliver the above benefits. They would work alongside a new urgent community response service, able to see people in their own homes.
The current MIUs treat minor injuries only; they cannot provide care and treatment for illnesses. An UCC, on the other hand, would offer broader urgent care by offering clinicians with advanced or enhanced urgent care skills; same-day tests or investigations where appropriate; access to x-ray; and treatments that may reduce the need to travel to an Emergency Department.
The wider network of urgent care services (e.g. GPs, pharmacists, dentists, eye care) would be largely unchanged, though PTHB would work with local partners to consider options to provide more minor injury services in areas where the current MIU closes.
Concentrating urgent care services on fewer community hospital sites would also allow clinical staff to work together more closely and see more patients, which would increase opportunities for skills development, training, peer support and professional development.
To what extent do you agree or disagree with the proposed model of care for urgent care services? (please tick one option only)
Two options have been identified as feasible.
Both options would increase the level of urgent care assessment, diagnosis and treatment available in the county. While both would mean longer journeys for some patients, analysis suggests that some people who currently attend Emergency Departments outside Powys could receive care within the county instead.
A MIIU in Llandrindod Wells (included in Option 1, but not Option 2) would not provide the same level of service as a UCC but would increase the level of assessment and treatment for illnesses compared with the current MIUs. Option 1 would therefore retain more local access to urgent care in mid-Powys but would require greater investment (and therefore leave fewer resources available to invest in other primary and community services to support urgent care needs). Option 2 would concentrate urgent care at Brecon and Newtown and require less investment, but more people would need to travel further to access it.
If urgent care services were to be provided on fewer sites, which of the following options do you believe best achieves the vision and responds to the case for change? (please tick one option only)
If there are any additional comments you would like to make about the proposals for urgent care services, please write these below. These might include:
Please read the relevant section of the consultation document
Mental health services in Powys are currently provided through a combination of primary care, community teams, outpatient services, crisis support and inpatient services. Alongside this, people with mental health issues may access more specialist services from providers outside the county. When inpatient care is needed this is provided from 38 beds at three locations: Bronllys, Llandrindod Wells and Ystradgynlais.
Demand for mental health services is continuing to rise, and PTHB finds that recruiting and retaining specialist staff is difficult. This means that small inpatient units can struggle to maintain sustainable staffing levels. Moreover, too many patients need to travel out of Powys for specialist care; and there are not enough alternatives to hospital admission for people experiencing mental health crisis, or enough step-down support for people ready to leave inpatient care but who need further support before returning fully to the community.
People have told PTHB that they want easier access to support, earlier intervention, and services that are better connected and easier to navigate. Many also want more support available closer to home and fewer situations where problems reach crisis point before help is available. The proposed future model of care has therefore been designed to offer joined-up care that supports people at different stages of need. It aims to ensure that support is available as early as possible, helping people remain well, avoid crisis, and receive care in appropriate settings.
Specifically, the proposed model seeks to:
If inpatient services are consolidated into a single centre of excellence, mental health beds would no longer be provided at other locations in future, and some people needing inpatient care would have to travel significantly further. However, PTHB believes that bringing services together would allow a wider range of specialist professionals to work more closely as a multidisciplinary team, improving access to assessment, treatment, rehabilitation and recovery support. It would also enable the expansion of community mental health services, crisis support, early intervention, rehabilitation and recovery services. PTHB aims to help more people receive support earlier, avoid hospital admission where possible and return home more quickly when admission is required.
To what extent do you agree or disagree with the proposed model of care for adult mental health services? (please tick one option only)
Following a detailed review and an appraisal of options (see consultation document for details), PTHB proposes that if a single centre of excellence for mental health is created in line with the proposed model, this should be in the Bronllys/Brecon area with 35 inpatient beds. PTHB believes this is the only option that could be delivered feasibly and affordably; and could be staffed sufficiently and sustainably because of the rural nature of Powys.
The single centre of excellence would be supported by strengthened community services, aiming to reduce the need for hospital admission either inside or outside the county; an improved single point of access; and a new ‘sanctuary service’ to support people in crisis, provided from two locations, one in north and one in south Powys.
Under this proposal, inpatient mental health services would no longer be provided from Ystradgynlais and Llandrindod Wells, and patients who need to stay in hospital would be cared for in the Bronllys/Brecon area.
If there was to be a single centre of excellence for mental health inpatient care, to what extent do you agree or disagree that it should be located in the Bronllys/Brecon area? (please tick one option only
If there are any additional comments you would like to make about the proposals for adult mental health services, please write these below. These might include:
Are there any additional comments you would like to make? These might include comments on:
• PTHB’s vision and case for change
• The proposals for physical health, mental health, or urgent care and how they relate to each other
• Any other alternative solutions to address the challenges that you think PTHB should consider.
The NHS has a duty to take into account the impact of decisions on human rights and people with protected characteristics under the Equality Act 2010 (age, disability, sex, gender reassignment, marriage and civil partnership, pregnancy, maternity, race, religion or belief, and sexual orientation) and comply with the Welsh Language Standards under the Welsh Language (Wales) Measure 2011.
Are there any positive or negative impacts that you believe should be taken into account in relation to equalities, human rights or Welsh language? If so, are you able to provide any supporting evidence and suggest any ways in which the organisations could reduce or remove any potential negative impacts and increase any positive impacts?
If you are responding on behalf of an ORGANISATION or in some official capacity, which organisation do you represent/in what capacity are you responding? Where relevant, please give us the title of the official role, or name of the organisation and any specific group or department. Please also tell us who the organisation represents, what area the organisation covers and how you gathered the views of members.
If you are providing your own PERSONAL RESPONSE, please answer the questions below.
The NHS has a duty to promote equality, and they want to make sure that we include all parts of the community in the consultation, but these questions are optional. We will take all responses fully into account, regardless of whether you provide your details.
What is your full postcode? This will help us understand views in different areas
please tick only one box for each question unless otherwise stated
What was your age on your last birthday?
Under 25
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75+
Prefer not to say
Are you?
Male
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Prefer to self-describe
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Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months (include any problems related to old age)?
Yes, limited a lot
Yes, limited a little
No
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Do you look after or give support to any family members, friends, neighbours or others because of long-term physical or mental ill health/disability or problems relating to old age?
Yes
No
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Do you have any dependent children aged under 18?
Yes
No
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What is your ethnic group?
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Can you understand, speak, read or write Welsh? (please tick any that apply)
Understand spoken Welsh
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None of the above
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We encourage you to complete the questionnaire online where possible. The deadline to tell us what you think, so your opinions can be included in the consultation, is 10 January 2027. You can do this by: