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Better Together: An update for Powys politicians from Dr Carl Cooper and Pete Hopgood

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Dear Colleagues

Powys Teaching Health Board Better Together Programme

Since 2024, Powys Teaching Health Board has been working with the public and our partners to develop our Better Together programme, our major transformation programme for redesigning health and care services in Powys.

We hope this letter helps to set out the current position and next steps.

To summarise the information on the following pages:

  • The current work focuses on adult physical and mental health community services and includes some all-age diagnostic services and Minor Injury Unit services, for people aged one and over.
  • We are still at an early stage with this work and no decisions on options have been made by the Board. However, bold decisions will be needed to ensure that services are fit for future generations.
  • In September 2026 the Board will consider whether we are ready to begin a formal public consultation on potential options for change.
  • Decisions following full and meaningful consultation with the public, partners and staff are expected no sooner than Spring 2027.
  • There are no plans or proposals to close any community hospital sites in Powys.
  • Useful information is available from our website pthb.nhs.wales/BetterTogether and you can sign up to regular news alerts pthb.nhs.wales/subscribe

 

 

Overview

We are very grateful to colleagues for the continued partnership to develop and deliver our joint Health and Care Strategy for Powys. This strategy was informed by thousands of voices across Powys and, through this, we have agreed a shared ambition: to help people stay healthy and independent for longer, provide more care closer to home, and ensure services remain safe, sustainable and of high quality for future generations.

Delivering that vision requires us to respond to a number of significant challenges, including changing health needs, workforce pressures, and increasing demand for services in the context of the financial constraints facing all public services. Our Better Together programme has been established to explore how we can transform services so that they are better able to meet the needs of people across Powys, now and in the future.

We are still at an early stage with this work, and no decisions have been made by the Board about any of the ideas or options under development.

In September 2026, the Board will consider whether we are ready to begin a formal public consultation on potential options for change. Decisions following full and meaningful consultation with the public, partners and staff are expected no sooner than Spring 2027.

 

What has happened so far?

We are tremendously grateful to the thousands of participants who have contributed to this work so far:

Based on this work it has become increasingly clear that “no change” is not an option. We know that older people can experience harm and deconditioning from hospital admission. We also know that over half of patients currently in a community hospital bed could be better cared for at home, if the right community health care services available. Community Hospital beds will remain an essential and valuable element of any future service model, but they need to play the right role as part of a health care system designed for the future.

Instead, we need to find solutions for the future that:

  • Put greater focus on preventing ill health.
  • Get better at supporting people to stay well at home, taking action before their condition deteriorates so that fewer people need admission to hospital.
  • Determine the best way to provide bed-based services in the future, providing a higher level of care within the county, so that we reduce length of stay and reduce the need for admission to a District General Hospital.

The right solutions will need to bring together skills and talents from across the county. Working together with primary care, social care, the third sector and our population is essential.

 

What ideas are being considered?

There are no plans to close any hospital sites in Powys. But it is right that we take the time to carefully consider a wide range of options – looking at how we strengthen primary and community services, and how we provide bed-based care in the best possible way for the future. 

Detailed options are being developed based on the scenarios put forward last year by public, staff and stakeholders:

  1. No change 
  1. Minor changes and developments to the way we provide physical and mental health community services 
  1. More services provided within “centres of excellence” including in Rural Regional Centres. This would mean that some of our services (such as hospital beds) are provided in fewer locations than now 
  1. Developing and expanding the range of services available at home through strengthened primary and community teams 
  1. Inpatient care, including community hospital beds, is provided outside the county in neighbouring health boards 
  1. Provide a District General Hospital in Powys 

At that time in 2025, scenarios 1 and 6 were discounted. “No change” is not an option as change is needed in order to ensure that health services are safe and sustainable for the future. And there are no safe or feasible options for providing a District General Hospital in Powys. 

Scenario 5 has also been discounted and community hospital beds will continue to be provided in the county. 

We anticipate that these scenarios will form the basis of the detailed options for formal consultation later this year.

We recognise that some of these scenarios would affect which services are delivered from each community hospital site. Depending on the decisions made following consultation, we are keen to work with the public and our partners to make sure that each site has a clear and vibrant role that supports future wellbeing in line with the Welsh Government’s Community by Design programme.

 

What was discussed at our Board meeting on 29 July 2026?

Our Board meetings can generate some media interest, so we felt it would be useful to share the discussions that took place at our meeting on 29 July.

The main focus for the Board was an assurance report on the work on the Better Together programme to date. The discussion focused on why change is needed, the evidence and engagement work that has taken place so far and the steps being taken towards presentation of a Pre-Consultation Business Case to the Board in September. Board members heard how engagement with communities, staff, partners and stakeholders has helped shape the emerging work, alongside clinical advice, modelling, pathway testing and independent assurance.

The presentation to Board members included “Delyth”, the first of several personas under development. These are hypothetical patients that demonstrate how different people could benefit from transformed services.

Alongside this assurance report, the Board also discussed and approved the Consultation Plan. This focuses on how we will consult. It does not yet set out what the consultation options will be, as these are due to be discussed at our meeting in September. The plan includes a range of ways for people to take part, including public drop-in events in all 13 Powys localities, outreach activity with community groups, independently facilitated focus groups, accessible consultation materials and independent analysis of the feedback received.

More information will be available in September once details are confirmed.

Videos from the meeting are available on our YouTube channel:

The videos above, along with an update from the Board meeting, are also available from our website. A copy of the assurance report and draft consultation plan considered by the Board is available from our Better Together Technical Documents page.

 

What happens next?

We recognise that discussions about the future of local health care services matter deeply to people and can create concern or uncertainty. That is entirely understandable.

However, we also know that maintaining the status quo is not an option if we want health care to remain safe, high quality and able to meet future needs. We believe this is the right time to have an open consultation about how we build a stronger model of care for future generations in Powys.

Importantly, Better Together is not primarily driven by financial considerations. It is about creating a modern, rural health care system that delivers high-quality care, in the right place, at the right time, for the communities we serve.

Useful information about the Better Together programme is available from our website at pthb.nhs.wales/BetterTogether. This includes the Case for Change, background technical documents, engagement reports, and our recent Board meeting reports. You can also sign up to regular news alerts at pthb.nhs.wales/subscribe

 

We look forward to continuing to work with you on the important work ahead

Yours sincerely,

Dr Carl Cooper, Chair
Pete Hopgood, Acting Chief Executive