Better Together: Why do we not have a District General Hospital in Powys
Powys covers a large area, but it has a small population—around 133,000 people. This means there are just 26 people per square kilometre - compared with an average of 150 per square kilometre across Wales. In fact, Powys is the most sparsely populated county in the whole of England and Wales.
This combination of size and sparsity creates unique challenges for healthcare provision.
Population and Scale
District General Hospitals (DGHs) are designed to serve large populations because they need to bring together a wide range of specialist services and staff to provide safe, 24-hour emergency care. Clinical experts recommend that a DGH should serve a population at least three times the size of Powys. With only 133,000 residents spread across a vast rural area, Powys simply does not have the critical mass to sustain such a facility.
Geography and Accessibility
Even if a DGH were built in a central location in Powys (e.g. Llandrindod), many residents in north and south Powys would still be closer to hospitals in neighbouring counties. This means that a single site could not bring together the skills and expertise to treat medical and surgical emergencies 24 hours a day. Instead, it is better and safer for patients to be treated in hospitals in neighbouring counties that can bring together the right specialists in one place.
Workforce Challenges
Running a DGH requires a large team of specialists available 24/7, including emergency consultants, surgeons, intensive care teams, and diagnostic experts. It also requires nurses, therapists and healthcare scientists with skills and experience in different health conditions. And it needs all the vital support staff - catering, cleaning, portering and much more besides. Recruiting and retaining such a workforce in a rural area like Powys is not feasible.
It would be extremely difficult to attract specialist staff to work in a small rural hospital, and they would see a very small number of complex cases which would make it hard for clinicians to maintain their skills.
Current Approach
Instead of a DGH, Powys Teaching Health Board focuses on providing care locally through GPs, community hospitals, and home-based services. For specialist and emergency care, Powys commissions services from neighbouring health boards in Wales and NHS Trusts in England. This model ensures residents can access safe, high-quality care when needed, while making the best use of resources.
We hear anxieties about the distance to district general hospital, ambulance response times, and whether more services could be provided safely in the county. This is why we have established the Better Together programme, to shape the future of safe, quality health services for Powys.