Find out more about the consultation in our frequently asked questions below. These will be updated throughout the consultation.
Last updated 23 October 2026
Better Together is a long-term programme to develop health services that are safe, sustainable and able to meet the needs of future generations in Powys. The direction is to move from a system that can be too reliant on hospital care towards one that provides more prevention, earlier help and care in people’s homes and local communities where this is safe and appropriate. Hospital, specialist and inpatient care would remain important when people clinically need it.
The proposals aim to help more people stay well and independent for longer; provide earlier support when health begins to deteriorate; strengthen urgent care within Powys; improve rehabilitation and reablement; support safe discharge from hospital; strengthen mental health crisis and community support; and improve coordination between services. They also aim to reduce avoidable admissions and unnecessary journeys outside Powys where care can safely be provided closer to home.
It means designing services so that home and community support are a planned part of the health system rather than something considered only after hospital care. Depending on need, this could include community nursing, therapies, urgent community response, Hospital At Home, rehabilitation, reablement, mental health support, diagnostics, remote monitoring and better coordination between services.
No. The proposals do not remove the need for hospital care. Community hospitals would continue to have an important role and inpatient, emergency and specialist care would still be needed. The aim is to avoid hospital admission when a person can be cared for safely elsewhere, and to avoid people remaining in hospital longer than they need to because the right support is not available outside hospital.
The Case for Change identifies an ageing population, increasing demand, more complex health needs, workforce shortages, ageing buildings, financial pressures and difficulties sustaining some services across many small sites. It also identifies avoidable long hospital stays and reliance on care outside Powys. The assessment concluded that leaving the current model unchanged would not adequately address these longer-term pressures.
Financial pressure is one reason change is being considered, but it is not the only reason. The Case for Change also focuses on population need, quality and safety, workforce sustainability, access, ageing buildings and reliable services. An option still needs to be clinically safe, deliverable and capable of meeting future need; being cheaper would not be enough on its own.
The Case for Change does not say that staff are providing poor care. It says the current configuration is becoming increasingly difficult to sustain over the longer term because of issues such as small and dispersed teams, recruitment and retention, variation in service availability, estate limitations and increasing demand.
The current and previous service arrangements are shown as comparators. However, the options-development process concluded that maintaining existing arrangements would not adequately address the Case for Change. The consultation can still challenge that conclusion, the evidence behind it and the assumptions used.
The Case for Change was tested through engagement with patients, residents, staff, partners and stakeholders. Ideas also came from clinical and professional workshops, service reviews, technical analysis, staff and partner feedback, and deliberative events involving patients, service users and community representatives. Engagement helped shape the design principles, travel principles and assessment criteria used to develop and test the options.
The Health Board used a five-step process from understanding the need for change through to appraisal and assurance. Options were tested for clinical sustainability, access, deliverability, strategic fit and financial sustainability, alongside workforce, finance, estates, demand and capacity, travel, patient pathways, equality and quality impacts, clinical challenge and independent assurance.
No. The options are not presented in order of preference and approval of the Pre-Consultation Business Case was approval to consult, not approval to implement an option. Consultation responses, alternative proposals, updated impact assessments and additional evidence must be considered before recommendations and decisions are made. New ideas and new evidence will be taken into account before decisions are made.
No preferred option is identified in the consultation document. The consultation asks people to consider the benefits, disadvantages and impacts of the options and to suggest changes or alternatives.
However, based on detailed work so far, one option has met the relevant tests to proceed to formal consultation.
The consultation period may put forward new ideas and suggestions which will be considered before any decisions are made.
Alternative proposals can be put forward. They would be considered against the underlying challenges and relevant criteria, including safety, access, deliverability, workforce, sustainability and impact. Consultation can also identify practical changes or mitigations that could improve the proposals.
Both options strengthen community services and change the configuration of community inpatient beds. Option 1 would provide 90 physical health community inpatient beds in three Rural Regional Centres in Brecon, Llandrindod Wells and Newtown. Option 2 would provide 60 beds in two Rural Regional Centres in Brecon and Newtown. The intention is that these beds provide an expanded range of inpatient, rehabilitation and recovery care.
Both options propose enhanced Urgent Care Centres in Brecon and Newtown for a broader range of same-day, non-life-threatening urgent illnesses and injuries, combined with a wider range of diagnostic services.
Option 1 would retain a Minor Illness and Injury Unit (MIIU) in Llandrindod Wells, which would also include a wider range of diagnostic services, open 7 days a week. It would also include non-obstetric ultrasound in Brecon, Llandrindod Wells and Newtown and more point of care testing across Powys.
Option 2 would only have the two Urgent Care Centres in Brecon and Newtown, with a range of diagnostic services open 7-days a week, plus X-ray services in Llandrindod Wells 5 days a week without the MIIU. It would also include non-obstetric ultrasound in Brecon, Llandrindod Wells and Newtown and more point of care testing available throughout the county.
The current Minor Injury Units in Ystradgynlais and Welshpool would close. X-ray and diagnostic provision would also change in some locations, including the closure of X-ray services (1-day per week) in Machynlleth.
No. Powys would still not have an Emergency Department. Life-threatening emergencies would continue to require 999 and an appropriate Emergency Department. The proposed Minor Injury and Illness Unit (MIIU) and/or Urgent Care Centres (UCCs) are intended to assess and treat a wider range of urgent but non-life-threatening conditions within Powys.
The proposal aims to strengthen community mental health services to focus on prevention, recovery and early help. And for community services, crisis support, and inpatient care to work together smoothly. The option creates a joined-up mental health pathway that offers alternatives to admission, while bringing adult functional and older adult organic mental health inpatient services together on one 35-bed Mental Health Centre of Excellence in the Bronllys/Brecon area. The intention is to improve the therapeutic environment, clinical resilience and workforce sustainability while reducing avoidable admissions and out-of-county placements. No other safe and realistic option for adult mental health met the tests for public consultation.
No individual proposal is wholly dependent on another proceeding. However, some anticipated benefits depend on strong links between community services, urgent care, rehabilitation, physical health, mental health, primary care, social care and voluntary-sector support.
No. The principle is to shift our focus so that health care services are designed around the person and what they need, rather than around existing buildings. This means asking where and how someone can receive the best care, rather than automatically providing care in a hospital because this is where services have traditionally been based.
Both adult physical health options would reduce the number of community inpatient beds and concentrate them on fewer sites. Evidence shows keeping beds on more sites makes services harder to staff and sustain. That is a significant proposed change, with beds closing in Bronllys, Llanidloes, Machynlleth, Welshpool, Ystradgynlais and optionally, Llandrindod Wells under Option 2 for adult physical health. The proposals are based on a different model in which more people would receive prevention, urgent response, Hospital At Home, rehabilitation and reablement outside an inpatient ward. The consultation is asking whether that model, together with the proposed inpatient capacity, can safely and sustainably meet future needs.
The proposals are based on changing how and where care is provided, not if an older population will need less health care. The aim is to intervene earlier, provide more care at home and in the community, reduce avoidable admissions, shorten unnecessary hospital stays and use inpatient beds for people whose clinical needs require them. The proposed bed numbers are based on wider demand and capacity modelling. The consultation can challenge whether the proposed community and inpatient capacity is sufficient.
A hospital bed is sometimes the safest and most appropriate place for care. However, once someone no longer needs that level of inpatient care, an unnecessarily long hospital stay can contribute to deconditioning, including loss of muscle strength, mobility and confidence, particularly for older people and people living with frailty. Avoiding unnecessary time in hospital therefore helps reduce preventable loss of function and independence.
The options seek to balance access with clinical quality, workforce resilience and sustainable services across a large rural area. The consultation should test the travel, equality, community and cross-border impacts and whether proposed mitigations are credible.
It should not mean simply transferring clinical responsibility to families. Hospital At Home, for example, is hospital-level care for selected patients with an NHS clinical team remaining responsible. However, the impact on carers is important and the consultation needs to consider people who live alone, have limited informal support or have caring responsibilities.
People would need to be clinically suitable for home-based pathways and there must be clear arrangements for rapid escalation if their condition worsens. Home-based care is not intended for people whose needs cannot safely be managed outside hospital.
The proposals depend on strengthened community services, workforce, facilities and supporting systems. The pace of implementation would depend on staffing, funding, buildings and the availability of supporting services. The conditions needed for safe change would need to be demonstrated rather than simply assumed.
No community hospital site is proposed to close through this consultation. However, that does not mean every service currently provided at every site would remain there. The role of some sites and the location of some inpatient, urgent care and diagnostic services would change.
A change to one service does not automatically mean the hospital building closes. The Health Board says it would continue to work with communities and staff on the future role of individual sites. This consultation does not provide a final future service plan for every building.
Better Together is not only about changing how community hospital beds are used. It also aims to provide more care within Powys and help people return closer to home when they no longer need the specialist care of a District General Hospital.
By strengthening community services and providing a broader range of inpatient, rehabilitation, diagnostic and urgent care within Powys, the aim is for some people to be cared for locally or to return closer to home sooner when specialist treatment elsewhere is complete. People would still need District General Hospital, emergency and specialist care outside Powys when that is clinically appropriate.
Some specialist and complex care, like a District General Hospital (DGH), cannot be safely provided in Powys. Big hospitals need large teams, specialist equipment and enough patients to keep their highly skilled staff. Our nearest DGHs are in neighbouring counties in Wales and England.
Yes. Some options would mean longer journeys for some patients, families and visitors for inpatient care, urgent care or diagnostics. The proposed model aims to balance this against more care at home and locally, enhanced urgent care within Powys and fewer avoidable journeys outside the county. Travel impacts are an important part of the consultation.
Public transport is challenging due to the sparse, rural nature of Powys. Other issues, including car availability, cost, disability, caring responsibilities and journey times can all affect access. Travel, equality and socio-economic impacts have been assessed, but consultation feedback is important for identifying impacts that modelling may not fully capture and for developing possible mitigations.
Many residents will continue to need acute, emergency and specialist services outside the county, and existing arrangements with neighbouring providers are not directly changed by this consultation. Some border communities also use walk-in urgent care outside Powys; the consultation document identifies these arrangements as unaffected.
Yes. The programme includes equality and other impact assessments, including Welsh language, socio-economic, travel and community impacts. These assessments can be updated in response to evidence received through consultation.
No. Stronger community services are intended across Powys, but the impact of the hospital, urgent care and diagnostic options differs by locality. Some areas would gain an expanded range of inpatient or urgent care services; in others, some hospital-based services would move. The consultation document contains locality-by-locality information.
Under Option 1 it would be provided in Brecon, Llandrindod Wells and Newtown. Under Option 2 it would be provided in Brecon and Newtown. This means inpatient services would transfer from some existing community hospital sites over time if an option is approved.
Both urgent care options propose enhanced Urgent Care Centres in Brecon and Newtown. Option 1 also proposes a Minor Illness and Injury Unit in Llandrindod Wells. Existing MIU and X-ray arrangements would change in places including Welshpool and Ystradgynlais, and the limited X-ray service in Machynlleth would close.
There is a real trade-off. The proposals define ‘closer to home’ mainly through stronger home and community services and more care within Powys, while some inpatient, urgent care and diagnostic services would be concentrated on fewer sites. For some people that could mean less travel overall; for others who need those particular hospital-based services it could mean travelling further. The consultation is intended to test that balance.
No changes would happen immediately as a result of consultation. The consultation runs from 5 October 2026 to 10 January 2027, with decisions currently expected in Spring 2027. If changes are approved, detailed planning would follow and implementation would be phased over several years. The full programme could take up to ten years.
No. They are indicative timelines showing how implementation could develop if decisions are made in Spring 2027. They do not predetermine the outcome and would adapt to the decisions made, consultation feedback and practical conditions for implementation.
The Pre-Consultation Business Case includes financial appraisal and planning assumptions, but detailed costs, funding routes and capital requirements would continue to develop. Some proposals depend on investment in workforce, community capacity, estate, equipment, digital systems or capital. Affordability and deliverability therefore remain part of decision-making.
The pace and sequencing of change are intended to depend on the necessary workforce, community capacity, infrastructure and other enabling arrangements being in place. If those conditions cannot be demonstrated, the implementation plan would need to change rather than proceeding on the assumption that the required services exist.
No. This is a consultation about proposed service changes. It does not make decisions about individual jobs. If following this consultation decisions were made to approve service changes that impact on people's jobs and roles, a separate organisational change process would follow with affected staff and staff-side representatives from trade unions and professional associations, following the All-Wales Organisational Change Policy.
No decision has been made about any individual job. If service changes are approved, the starting point would be to retain staff knowledge, skills and experience wherever reasonably possible. Detailed workforce plans would be developed with staff and trade unions, and the intention would be to manage change carefully and seek to avoid compulsory redundancies wherever reasonably possible.
We don’t know yet, because no decisions have been made about individual jobs or roles. If changes are approved, some roles may stay broadly the same, some may change, and there may be new opportunities as services develop. Any changes would be made through the NHS Wales organisational change process, working with staff and trade unions.
We have carefully considered whether different ideas and options have a credible and realistic workforce model. The options put forward as part of this consultation are those that best met the core tests covering factors such as workforce, quality, outcomes, feasibility. This was based on the detailed analysis set out in the Pre-Consultation Business Case and its supporting papers which describe the workforce assumptions, dependencies and phasing. This public consultation provides a route for staff, partners and the general public to challenge the evidence presented with the papers and identify risks or alternatives.
When the consultation process is complete all of the responses will be independently analysed by Opinion Research Services Ltd. They will prepare a report which sets out the issues heard during the consultation. This report together with any new and existing evidence will be combined into a large and detailed report called a post-consultation decision case. This process is called conscientious consideration. The post-consultation decision case will be considered at a meeting in public of the Board of Powys Teaching Health Board where a decision will be made on the next steps.
No final service-change decision will be made until after consultation and the process of conscientious consideration has been completed by the Board in public. Feedback will be independently reviewed, and the Board will consider what people have said alongside the evidence. The current plan is for this to come back to the Board in spring 2027, but the final timetable will be confirmed and published.
No. All feedback received during the consultation will be taken on board. This includes new ideas, new evidence, or information about the potential impacts. Consultation responses, alternative proposals, updated impact assessments and additional evidence must be considered before recommendations are put forward and decisions are made.
All relevant consultation submissions will be logged and considered using a transparent analysis method. This is being managed independently from the health board by Opinion Research Services, who will consider ensure that all petitions are recorded in the consultation findings report. The weight given to evidence is not a simple count of identical responses; decision-makers must consider the substance, impacts and evidence presented. The entire consultation process is subject to independent oversight and review by HICO. Llais, the statutory Citizen Voice Body in Wales, also has a key role including making representations on matters it considers of importance based on what they have heard from people.
No preferred option is identified in the consultation document. The consultation asks people to consider the benefits, disadvantages and impacts of the options and to suggest changes or alternatives.
Yes.
Putting forward alternative proposals is a vital part of this consultation. The Health Board will consider them against the underlying challenges and relevant criteria, including safety, access, deliverability, workforce, sustainability and impact. The consultation can also identify practical changes or mitigations that could improve the proposals.
The consultation is planned to run for 14-weeks from 5 October 2026 until 10 January 2027.
We want views on whether the proposals address the challenges facing services, their positive and negative impacts, how negative impacts could be reduced, and whether there are other workable ideas or alternatives. Evidence and practical examples are particularly useful because they can help test assumptions and improve impact assessments.
Yes. Consultation is not simply a choice between supporting or opposing the programme as a whole. You can say which elements you support, which concern you, why, and what you think should change. You can also suggest mitigations or alternative approaches.
No final decision has been made. Responses, alternative proposals, updated impact assessments and additional evidence will be considered before recommendations and decisions are made. The purpose of consultation is to test and inform the proposals, not to communicate a decision already taken.
Explain what you think would work or not work and why. Where possible, give examples, evidence or practical experience; describe who could be affected and how; identify unintended consequences; and suggest an alternative or a way of reducing the impact. Positive feedback is useful too—if you think something would improve care, explain what benefit you expect and why.