Better Together – A vision for the future
4 November 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
The latest in our series of regular Better Together articles describes the vision for future health care services in Powys.
You can read the Full Consultation Document on our website or find out more by reading the "A vision for the future" chapter below.
This chapter describes the vision for future health care services in Powys. It explains what we want services to look like in the years ahead, shaped by evidence, national policy and what people have told us is important to them.
Looking Ahead
We know that many people reading this document will focus on the proposals for specific services such as inpatient beds.
But the proposals within Better Together are about far more than beds and buildings; they are about creating a sustainable health care system that can meet the needs of current and future generations across Powys.
The evidence presented in earlier chapters shows that demand is rising, the population is ageing, workforce challenges continue to grow and financial pressures are increasing. At the same time, people have consistently told us they want services that are easier to access, better connected and more responsive to their needs.
Our vision is to create a system 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 proposals in this consultation represent an important step towards achieving that vision.
Our Ambition
Our ambition is to focus on prevention. Early help and proactive care, helping people to stay independent and supported in their homes and communities as long as possible.
Stay well and independent
Many of the health challenges facing Powys cannot be solved by the NHS alone. Our vision therefore places a greater emphasis on prevention and healthy lifestyles.
By helping people stay healthier for longer, we can improve quality of life while reducing pressure on health care services.
This approach reflects national policy and is consistent with the principles of prudent health care and the Well-being of Future Generations (Wales) Act.
Everyone living and working in Powys has a role to play.
Early help and proactive care and support is available
Proactive prevention means identifying people who may be at greater risk of becoming unwell and offering support earlier, before they reach a crisis point or need hospital care. Rather than waiting for someone to seek help when their condition worsens, services work together to spot signs of increasing need and provide timely support to help people stay healthy, independent and connected to their communities.
For example, information about long-term conditions, frailty, previous service use or other risk factors can help community teams target help where it may have the greatest impact.
A key part of this approach is a Single Point of Access (SPOA), making it easier for people, carers and professionals to find the right help quickly. The SPOA helps coordinate support, reduce confusion about where to go for assistance and ensure people can access the most appropriate service at the right time.
In simple terms, proactive prevention is about helping people stay well for longer, preventing problems from becoming crises and supporting more care closer to home.
- Example: Single Points of Access
Single Points of Access would provide one route into adult physical health and into mental health community services. Patients, carers and professionals would no longer need to navigate multiple teams independently. The service would help ensure people are directed quickly to the right service and receive coordinated support across different organisations.
Care at home and in the community
One of the strongest messages we heard during engagement was the importance of local access to services.
People told us they value community services and want care to remain as close to home as possible.
Our vision is therefore built around a principle of delivering care in the most appropriate setting. Where safe and appropriate, health care should be delivered in people’s homes, or in the most local facility with the range of skills and equipment available to meet their health care needs.
This means:
- Supporting people in their own homes whenever possible.
- Strengthening community nursing and therapy services including rehabilitation and reablement
- Improving our approach to rehabilitation and community-based diagnostics.
- Improving links between primary, community and hospital services.
To achieve this, health care needs to be based more around people and their needs; less around buildings and organisations.
- Example: Rehabilitation
Rehabilitation services would support people to regain strength, confidence and independence following illness, injury or hospital admission. This could include physiotherapy, occupational therapy, speech and language therapy and multidisciplinary support delivered either at home. People needing more intensive rehabilitation could receive this in an inpatient setting.
Specialist community support
We want to make more specialist community support available for people with more complex or urgent needs.
Many people tell us they want to remain independent for as long as possible.
Independence is important not only for quality of life, but also because it can help improve health outcomes and reduce reliance on hospital care.
Our future model therefore aims to:
- Support people to recover at home.
- Provide coordinated support following illness or injury.
- Help people avoid unnecessary admission to hospital.
- Reduce dependence on inpatient services.
Where hospital admission is necessary, services should support people to return home as soon as it is safe to do so.
This includes palliative and end of life support, sanctuary for mental health crisis, Hospital At Home and urgent community response.
- Example: Hospital At Home
Hospital at Home would provide hospital-level assessment, treatment and monitoring in a person's own home. This could include intravenous antibiotics, treatment for chest infections, support following deterioration in long-term conditions, monitoring following discharge from hospital, and some forms of end-of-life care. Rather than automatically being admitted to hospital, more people would be able to receive treatment and recover at home surrounded by family and familiar support networks. - Example: Urgent Community Response
Urgent Community Response would provide rapid assessment for people whose health suddenly deteriorates at home. Our goal would be to attend within two hours of contact. This could include people who have fallen, developed an infection, become acutely confused, or are experiencing worsening frailty. Instead of attending an Emergency Department, more people could receive assessment, treatment and support in their own home. - Example: Mental Health Sanctuary
A mental health sanctuary would support people experiencing emotional distress or a developing mental health crisis who need immediate support, but do not require admission to a mental health inpatient ward. For example, someone struggling to cope following a sudden deterioration in their mental health, experiencing intense anxiety, loneliness or thoughts of self-harm, could access a safe and supportive environment where they can receive emotional support, practical help and guidance to appropriate services. The aim is to provide help at an earlier stage, preventing situations from escalating to the point where hospital admission becomes necessary.
Hospital services in Powys
Hospital services in Powys are available when needs cannot be met safely in the community, including inpatient beds and urgent care centres. Hospital care will remain essential, but hospitals only should be used when required due to the complexity of a person's needs.
Hospitals in Powys should also be able to care for more people who are currently admitted to DGH outside the county. This will also reduce the risk that services are lost from the county.
- Example: Physical Health Inpatient Beds
Inpatient beds would continue to support people whose needs cannot be safely met at home, but who do not require the specialist services of a District General Hospital. For example, someone recovering from a serious illness, injury or fall may need a short period of nursing care, rehabilitation and therapy to help them regain strength and independence before returning home. - Example: Mental Health Inpatient Beds
Mental health inpatient beds would support people who are experiencing severe mental ill health and need a period of intensive treatment and support that cannot be provided safely in the community. The focus would be on stabilisation, recovery and helping people return home with the right ongoing support as soon as it is safe and appropriate to do so.
Hospital and specialist care outside Powys
As part of this model, we need to improve the way that health care in Powys works seamlessly with hospital and specialist care outside Powys.
As well as making sure that “information follows the patient” this includes improved “step up” care in Powys to reduce the need for DGH admission, and better “step down” care so that we can bring more patients back into county from DGH safely and swiftly.
Physical health, mental health and urgent care are treated equally
Mental health is fundamental to overall wellbeing. Throughout our engagement, people consistently highlighted the need to improve mental health services and provide earlier support.
Our vision is for mental health services that are:
- Easier to access.
- Available earlier.
- Better connected to physical health care services.
- Centred around individual needs.
- Focused on recovery and wellbeing.
We want mental health support to be considered an integral part of health care rather than a separate service.
This approach reflects growing evidence that physical and mental health outcomes are closely linked.
No wrong door
People often experience services as separate and disconnected. Many told us they have to repeat information, navigate complex systems and deal with multiple organisations independently. Our vision is for a more integrated approach, where professionals work together around the needs of the individual.
Integrated working should provide a better experience for patients while helping to make the best use of available resources. It should also help people with their choices at the end of life. It will be easier to provide joined-up care if we have a clear and consistent service model in all parts of the county.
Digitally enabled
Digital technology provides opportunities to improve access to care, particularly in a rural county such as Powys.
Technology will not replace face-to-face care where this is needed, but it can complement traditional services and provide greater flexibility.
Our future vision includes:
- Improved digital access to services.
- Virtual consultations where appropriate.
- Better sharing of information between organisations.
- Technology-enabled care and monitoring.
- Improved communication with patients and carers.
Digital solutions must remain inclusive and accessible, recognising that not everyone can or wishes to access care digitally.
Living within our means
Health care resources are finite. Every pound spent in one area is a pound that cannot be spent elsewhere.
Our vision seeks to ensure resources are used in ways that maximise benefits for patients and communities.
This means:
- Investing in services that deliver the greatest benefit.
- Reducing unnecessary duplication.
- Shifting resources towards prevention and community support.
- Ensuring services are financially sustainable over the longer term.
Financial sustainability is not an end in itself. It is necessary to ensure that services remain available and effective for future generations.
A skilled and supported workforce
None of these ambitions can be achieved without a sustainable workforce.
Staff are central to delivering high-quality care and supporting future service transformation.
Our vision includes:
- Creating attractive and rewarding career opportunities.
- Improving recruitment and retention.
- Supporting professional development.
- Enabling multidisciplinary working.
- Reducing unnecessary duplication and fragmentation.
By organising services differently, we aim to create more resilient teams that are better able to meet the needs of the population.
Examples of What This Means in Practice
Better Together for intravenous antibiotics
If you develop an infection that needs intravenous (IV) antibiotics, you may currently need to travel to hospital and stay in a bed while treatment is given.
Under the future model, appropriately trained community teams could provide IV antibiotics in your own home or in a local community hub. This would allow many people to receive the same treatment without a hospital stay, helping them remain independent and reducing the risk of losing strength and mobility while in hospital.
More support to remain at home at the end of life
Many people tell us they would prefer to spend their final days at home or somewhere familiar, surrounded by family and friends.
The future model would strengthen palliative and end-of-life care through better coordination between district nursing, specialist palliative care, hospice-at-home services, urgent community response teams, pharmacies and social care. This would help more people receive high-quality end-of-life care in the place they choose, with community hospital care available when needed but avoiding hospital admissions that may not be necessary.
Faster help when someone's health suddenly worsens
Today, people in Powys whose health deteriorates often have few alternatives to attending an emergency department or being admitted to hospital.
The future model would introduce Urgent Community Response and strengthen Hospital At Home services. For example, an older person with a chest infection, heart failure or worsening frailty could be assessed and treated at home, with monitoring and regular visits from health care professionals, rather than automatically being admitted to hospital.
Currently a patient with a blocked catheter overnight is likely to need a visit to DGH. With a skilled overnight team in Powys we are more likely to provide treatment at home, avoiding a journey to hospital.
Better diagnostic services in Powys Urgent Care Centres could offer rapid testing to get you home quickly, reducing the need to stay in a District General Hospital.
Specialist rehabilitation in your own home
After a stroke or hip fracture, many people currently require a longer stay in hospital while rehabilitation takes place.
The future model would provide more specialist rehabilitation at home. This means some people could return home sooner and receive physiotherapy, occupational therapy and rehabilitation support in familiar surroundings, helping them regain confidence and independence more quickly.
More tests and diagnostics
Availability of tests and diagnostics is inconsistent, and too many tests are only available outside the county.
The future model would strengthen diagnostic services linked to Urgent Care Centres, making it easier for people to access investigations such as X-rays and blood tests.
This would support earlier diagnosis and faster treatment decisions.
Short-stay assessment and treatment
Not everyone who becomes unwell needs admission to a district general hospital.
The future model would create community inpatient services that can provide short-stay assessment, diagnostics and treatment for up to 72 hours. This means some patients could receive rapid assessment, treatment and monitoring within Powys before returning home with community support, avoiding longer journeys and unnecessary admissions elsewhere.
Better support for people living with frailty
Many older people are admitted to hospital following a fall or a sudden deterioration in their health.
The future model would identify people at risk earlier and provide more proactive support through multidisciplinary teams, falls prevention, frailty services, rehabilitation and personalised care planning. This would help people stay healthier for longer and prevent some health problems from reaching crisis point.
Better joined-up care for physical and mental health needs
People with long-term physical health conditions often also experience anxiety, depression, dementia or other mental health difficulties. Currently, these needs can be assessed and treated by separate teams.
The future model would bring physical health, mental health, social care and voluntary sector services together more closely. For example, an older person living with heart failure and dementia could have support coordinated through a single multidisciplinary team, with professionals working together around the person's overall needs rather than treating each condition separately.
Faster help for problems that currently lead to an emergency department visit
For example, someone with a blocked catheter in the middle of the night may currently need to travel to an emergency department outside Powys.
Under the future model, an expanded community nursing and urgent response service could help more people receive treatment at home, avoiding long journeys and lengthy waits in hospital.
Getting The Balance Right
A key question throughout this work has been how to balance two important goals: providing care as close to home as possible and ensuring that hospital services remain safe, sustainable and able to attract and retain the staff they need.
We recognise that having inpatient beds closer to every community is appealing, particularly in a rural county where travelling longer distances can be difficult. However, the evidence considered through the Step Report and Pre-Consultation Business Case suggests that maintaining beds across more sites would make it harder to provide resilient services and to invest in the wider community support that many people need.
The proposals therefore focus on strengthening community services across Powys so that more people can receive care at home or within their local area. At the same time, they seek to ensure that inpatient services are organised in a way that is sustainable for the future and able to provide the right mix of staff, expertise and facilities when people need hospital care.
Further Information
The options presented in the following chapters represent different ways of achieving these aims.
The purpose of this consultation is to understand whether we have identified the right way forward and to hear the views of people who use, deliver and support health and care services across Powys.
More information about the Vision for the Future and how it has been developed is available in the Pre Consultation Business Case which can be found in the Supporting Documents section of our website.