An introduction to Better Together

26 October 2026

Powys Teaching Health Board is inviting people across Powys to help shape the future of local NHS services.

The consultation runs from 5 October 2026 to 10 January 2027 and seeks views on proposals for adult physical health, adult mental health, urgent care and some diagnostic services.

Thirteen locality events and three online events provide opportunities for people to meet the team, ask questions, discuss the proposals and then complete the questionnaire. Full details can be found at http://pthb.nhs.wales/BetterTogether

You can read the Full Consultation Document on our website or find out more by reading the "welcome" chapter below.

Thank you for your interest in this consultation about the future of safe, high-quality health care services in Powys. This is your NHS. Your views count.

Every day, health care services in Powys support thousands of people to stay well, recover from illness and injury, manage long-term conditions, maintain their independence and receive care with dignity and compassion.

We are proud of thousands of NHS staff working in hospitals, primary and community teams, and people's own homes across the largest and most rural county in Wales.

But the health care needs of Powys are changing:

People are living longer than ever before. This is welcome, but it also means more people are living with multiple long-term conditions, frailty and complex physical and mental health needs.
This means that demand for health care services is increasing, which is putting pressure on staff and services. We need to design services based on the needs of today and tomorrow. We cannot rely on the models of the past.
At the same time, the proportion of people of working age is reducing. Recruiting and retaining the workforce needed to keep services running in their current form is becoming increasingly difficult.
There is a pressing need to focus on prevention and public health. We need to shift our focus to tackling the root causes of ill health.
In the face of changing needs we must ensure that the NHS remains affordable to the public purse, now and in the years to come, in buildings that are fit for the future.

More information about health and wellbeing in Powys, why services need to change, and what we have heard can be found in Chapters 2 and 3.

We know that people value local services and want care to remain close to home. You have said this clearly throughout our engagement on the Better Together programme over the last two years. We also know that many people are concerned about access, travel, transport, communication and the future of local hospitals. These views have shaped the work on Better Together to date.

The proposals set out in this consultation seek to respond to these important concerns and meet our responsibility to ensure services remain safe, sustainable and able to meet future needs.

That is why we have established Better Together. It is our pledge to work with local people, our staff and partner organisations, to develop a plan that meets the needs of Powys communities over the next 10 years and beyond.

We are focusing first on adult physical and mental health community services – as well as some all-age diagnostic services and minor injury unit services for people aged one and over - and seeking your views by 10 January 2027.

In future years we will focus on planned care, and women & children’s services.

Our goal is to:

Prevent ill health so that more people stay well for longer.
Strengthen primary and community care services so that more support is available in Powys communities to help people stay well at home and maintain independence.
Reduce the need for hospital admission, either inside or outside Powys.
Improve the way different services work together to provide care.
Transform inpatient care in Powys so that even more care is provided in the county, reducing the need to travel outside the county for hospital care.
Support people better in their choices at the end of life.
Ensure earlier access to mental health support and crisis intervention services
Develop and support health care staff to meet the needs of the future.

Overall, this aims to change health care from a system that is “hospital by default” to one that is “community by design”. Too many people have preventable admissions to hospital which could be avoided if we could support more people to stay well at home.

More information about the vision for the future can be found in Chapter 4.

Over the last two years we have listened to thousands of voices across Powys. The views of our communities, our staff and our partner organisations have shaped the content of this document and helped us to understand what matters most to people when they access health care.

That is why many services would continue to be provided within homes and communities across Powys, or would be strengthened so that more health care services are available in your home:

Community nursing, therapies, rehabilitation, primary care and social care services would continue to be provided throughout the county.
Community hospitals would continue to play an important role in local health care although the role of hospital sites and the location of some services would change.
More care would be delivered in people's homes through enhanced community and Hospital At Home services.
Services would be better organised around the needs of local communities and localities.
Planned care services are not part of this consultation and would continue to be delivered through a network of local facilities.

Some services would change if the proposals in this consultation document were put in place:

A bigger focus on prevention and public health.
More early help and support to stay well and reduce deterioration.
Hospital At home and intermediate care services to look after you in familiar surroundings at home.
Urgent community response to reduce emergency admissions to District General Hospital.
Better support for hospital discharge to bring you back into Powys quickly and safely after a District General Hospital stay.
A more joined-up approach between physical and mental health services.

Based on careful consideration of safe and feasible options for the future, a series of proposals is being put forward for public consultation. All community hospital sites remain open in all of these proposals, particularly as services such as planned care and women & children’s services are not within the scope of this consultation. But the role of each site would change to help us better meet the needs for the future.

More information about how options have been developed can be found in Chapter 5.

Adult Physical Health Services

Based on the detailed assessment we have undertaken we believe that there are opportunities to strengthen the community services we provide in people’s homes including, proactive care, intermediate care, Urgent Community Response, reablement, rehabilitation and Hospital At Home. These steps would support more people to be cared for at home, help to reduce the need for hospital admission, and tackle the harmful cycle of deconditioning that can increase patients’ dependence on health and care support. By taking these steps, we would reduce the need for community hospital beds but also make better use of these beds to offer step-up care, step-down care, specialist rehabilitation and palliative & end of life care. This would mean that over the and over the next ten years we could move to a new model of community hospital inpatient care based on two options:

Adult Physical Health Care Option 1: Powys community hospital inpatient beds in three locations (Brecon, Llandrindod Wells and Newtown) – 90 beds total
Adult Physical Health Care Option 2: Powys community hospital inpatient beds in two locations (Brecon and Newtown) – 60 beds total

The principal difference between the options relates to the number and configuration of community hospital inpatient sites and beds, and the degree to which community services in people’s home would be expanded to deliver this approach. The options seek to balance local access with the need to maintain safe, sustainable and resilient services that can attract and retain staff and consistently meet standards of care.

More information about the options for adult physical health services can be found in Chapter 6.

Urgent Health Care Services

Based on the detailed assessment we have undertaken we believe that there are opportunities to strengthen the urgent community health care services we provide in Powys including Urgent Community Response. Alongside this, over the next ten years our current model of PTHB Minor Injury Units could provide a wider range of assessment and treatment services based on two options:

Urgent Health Care Option 1: Urgent Care Centres in Brecon and Newtown with Minor Illness and Injury Unit in Llandrindod Wells
Urgent Health Care Option 2: Urgent Care Centres in Brecon and Newtown

These proposals also include some all-age diagnostic services.

The principal difference between the options relates to the number of locations where these services are provided.

More information about the options for urgent health care services can be found in Chapter 7.

Adult Mental Health Services

Based on the detailed assessment we have undertaken we believe that there are opportunities to strengthen our mental health community services and make these more joined up with physical health services so that patients receive better care in their own homes. We propose investment in community mental health support, crisis response, open access models, 111 press 2, virtual services and alternatives to admission such as sanctuary services. We believe that we could provide better care for patients and help to reduce the need for out-of-county placements based on one option:

Adult Mental Health Care Option: All functional and organic mental health beds in Bronllys/Brecon area

No other feasible options have been identified that met the tests for public consultation.

More information about the option for adult mental health services can be found in Chapter 8.

These options are based on new models of care for adult physical health, urgent health care, and mental health. These models are not dependent on each other, but we can achieve more for Powys when they are delivered together as part of one connected system.

More information about the connections between the options can be found in Chapter 9.

Importantly these are not changes that could happen overnight. It could take up to ten years to fully implement the proposals set out in this document. This would ensure we can continue to work with staff and communities on plans for safe and sustainable community services, alongside work on the future role of each community hospital site so that citizen and staff voices continue to shape health care services in Powys that are fit for future generations.

More information about the possible timetable if options were agreed following consultation can be found in Chapter 10.

We recognise that the location of beds will be a keen focus of interest during this consultation. Travel times for patients, families and carers are an important consideration, particularly in a rural county such as Powys.

However, we also know that most people want to remain independent and live in their own homes for as long as possible. By investing more in care at home, rehabilitation, reablement, Hospital At Home, district nursing and preventative services, we can help more people avoid admission altogether, recover more quickly after illness, and maintain their independence. For many people, receiving the right care at home or in their community offers a better experience and can lead to better outcomes than a longer stay in hospital.

In practice, most people will receive health care from community services many more times during their lives than they will require an inpatient bed. The proposed models therefore seek to strengthen the services that benefit the greatest number of people, while maintaining community inpatient beds for those whose needs cannot safely be met at home.

Our goal is that more people who need health care receive it at home, maintaining their independence and connection to local support networks, and that better inpatient care is available when it is genuinely needed. This approach aims to provide the right care, in the right place, at the right time, while ensuring services remain sustainable for future generations.

So, we know that some difficult decisions will be needed so that health services are fit for the future. If we do not act now then some services may be lost from the county.

No decisions will be made until we have given you – our patients, our residents and communities, our staff, the organisations we work with – the opportunity to tell us what you think.

Any decisions will take into account the impact these options may have based on a wide range of factors such as equality, Welsh language, socio-economic impacts, workforce and environment.

More information about how we are taking into account the impact of these options can be found in Chapter 11. More information about what these options could mean for each of the 13 localities in Powys can be found in Chapter 12. Initial ideas for how the impact of these proposals could be tested can be found in Chapter 13.

This document, and the information we have published alongside it, aim to ensure that you can consider the proposed options, their benefits, disadvantages and impacts. It seeks your views on the options, potential impacts, and alternative approaches that should be considered before a final decision is made.

Consultation responses, alternative proposals, updated impact assessments and any additional evidence gathered through the consultation process will be conscientiously considered before any future recommendation is developed.

More information about what happens next and how decisions will be made can be found in Chapter 14.

We encourage everyone to read this document, participate in discussions and share their views by 10 January 2027.

This is your NHS, and your voice counts.

Many thanks

Dr Carl Cooper, Chair
Pete Hopgood, Acting Chief Executive
Kate Wright, Medical Director