Better Together: Why is change needed?
2 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 explains why change is needed.
You can read the Full Consultation Document on our website or find out more by reading the "Why do services need to change?" chapter below.
This chapter summarises what we have heard about the need for change. It shares headlines from the Case For Change including the feedback we have heard through our engagement over the last two years.
The “Case For Change”
Can adult physical and mental health community services in Powys continue to meet future needs if nothing changes?
The evidence we have heard indicates that the answer is no.
The dedication of health care staff & volunteers continues to help us improve outcomes and experience for the people of Powys. However, to ensure services that are safe, sustainable and high quality, we need to make changes to address the significant challenges for our adult physical and mental health community services – and also some all-age diagnostic services and our minor injury unit services for people aged one and over.
The feedback we have heard from communities and staff has helped us develop our Case For Change.
The main reasons that change is needed include:
Demand for health care continues to rise
More people are living longer. This is welcome. However, their needs are becoming more complex and this means that more people in Powys need health care. Often this is more than one health problem, affecting both physical and mental health, so they need care that is planned ahead, joined-up, and in the right place.
Demand for adult and older adult mental health services is projected to increase by up to 33% over the next ten years. At the same time, many people tell us they want earlier support, improved crisis services and better integration between mental and physical health care. We want that too.
During 2025/26, there were 44,000 hospital admissions for Powys residents. Powys residents were in hospital for a total of 156,000 ‘bed days’ with a cost of over £121 million. On average, 120 Powys patients were admitted to a hospital each day, and an average of 428 beds were occupied by Powys residents every day. Many of these patients cannot be cared for in Powys because they need the levels of specialist care that can only be provided in District General Hospital.
There is variation in the quality and safety of care
Staying in hospital for too long can make people weaker. Research shows that older people can lose a lot of muscle strength after just 10 days in a hospital bed. It can be similar to ageing 10 years. This is called “deconditioning.” Many older people who could walk without help before they went to hospital need help to walk after leaving.
Extended periods in hospital can contribute to other problems such as incontinence.
There are gaps where community alternatives to hospital admission could offer patients better quality, safety and outcomes of care. Too many people are currently spending too long in hospital, both within Powys and outside the county. We need to change this.
The way services are delivered can vary across the county, and different services don’t work together as well as they could. This can make the system confusing for patients and for staff, and patients may have to repeat things to different teams or wait too long.
The workforce is changing
Staff are our greatest asset, but recruiting and retaining the right people with the right skills is challenging in rural areas. It is particularly hard in the centre of Powys, as it is a long way to large population centres.
The proportion of people of working age in Powys is reducing. At the same time the number of people needing our services is increasing. This means there will be fewer staff to care for more people. We must change the way we deliver health services so that services remain safe, and we can continue to deliver them in the county.
Currently over 44% of the PTHB workforce is aged 51 and over. Population projections indicate that by 2043 Powys will have 6,512 fewer people of working age than in 2024. This will affect the availability of NHS workers from within our local communities.
Our teams cover large rural areas but serve quite small populations. It can be difficult to keep services running during periods of staff absence and when there are vacancies. It can be hard for our staff to maintain specialist skills if they only see a few complex cases.
Too many jobs are filled by temporary staff. This makes health care more expensive and has an impact on the cost and quality of the services we provide.
We need to focus more on prevention and public health
There is a pressing need to focus time and resources on prevention of ill health.
Work is needed across all partners to improve the building blocks for living longer in good health. This includes action on obesity, unhealthy alcohol consumption, smoking, poor levels of physical activity and other lifestyle factors that contribute to poor health. As well as action by organisations to “make the healthier choice the easier choice” we all have a responsibility for our own health.
Across society we must also focus on the wider building blocks for living longer in good health such as income, education and physical environment.
We need to live within our means
Better Together is led by our Duty of Quality, so money is not the main driver. But finance is a constraint and we must live within our means. We ended 2025/26 with a deficit of £33m but by changing the way we deliver services we could provide high quality care and better outcomes for more people at a lower cost.
If we do not change the way we provide services, then there will not be enough public money to meet increasing demand.
We need to focus on things that help the most, like preventing ill health, caring for people in their own communities, and effective use of our staff and buildings.
Our unique geography needs unique solutions
Too many services are planned around the needs of the past, rather than the opportunities for the future.
We need to shift our focus from staffing buildings that do not meet modern health care requirements to staffing people’s needs and health outcomes.
More health care in the home would support people to maintain their independence, reducing the need for hospital admission. Modern facilities would improve patient experience during their stay, improve patient outcomes and reduce the time that people spend in hospital. We currently spend a lot of money on keeping our buildings running and do not have enough funding to bring them up to modern standards. A clear route map for the future would help us focus investment where it is most needed.
Travel and access are also consistent issues raised with us by patients and the public. Many homes and communities are a long distance from major health facilities such as DGHs. We recognise that this brings costs and causes anxiety for many of our residents.
Many people welcome digital solutions but some face barriers
We have seen a lot of progress in using digital technology in recent years. There is more that we can do, including using technology to reduce the need to travel from home or out of the county. This work needs to recognise that some people do not have digital access or skills. The rurality of Powys can also affect access to phone signal and broadband.
Buildings that are fit for the future
Many health care buildings in Powys pre-date the NHS. In fact, PTHB has the oldest built estate of all health boards in Wales. Over a third (36%) of our buildings were built before 1948, compared with the Wales average of 12%.
They were designed for historic ways of delivering health care and not for the future. There are limits to the capital funding available to modernise our hospitals and build facilities. We need to make prudent decisions about the right ways to modernise hospitals and clinics in Powys that are affordable to the public purse.
What we heard from the people of Powys
Since 2024, thousands of voices have contributed to discussions about the future of health care services in Powys. This has included residents, patients, carers, staff, elected representatives, community groups, voluntary organisations and partner organisations.
A number of consistent themes emerged.
Civic pride
People are proud and passionate about local services, and their role in the culture and economy of Powys.
Some facilities were established by public subscription before the NHS was founded. We are very grateful that many services have benefited from community fundraising including from local Friends charities, from other trusts & charities, and from donations to our Powys Health Charity.
Travel and transport
People are concerned about the distance to DGH for planned and emergency care, with concerns about access to travel and transport (including ambulance services and public transport), pressure on the NHS, waiting times for planned care, and Emergency Department waits.
More prevention and earlier help
People recognise that Powys is at the forefront of an ageing population, and with an increasing number of people living with multiple health conditions – and that our workforce is also ageing.
People feel the impact of social isolation and loneliness in a sparsely populated county, and this can affect circles of support including for unpaid carers, and impact on mental & emotional health.
People felt services too often respond to problems once they have already become severe. People told us they want earlier intervention, stronger community services, and more support at home.
People say that more can be done to focus on prevention to reduce the future burden of ill health for individuals and society
Quality First
People describe varied patient and user experience, including concerns about equity of access between different parts of the county, and variation in quality of care.
People experience difficulties in communication between patients and the NHS. This includes ensuring that “information follows the patient”, particularly when you receive care in England.
Better coordination is needed
People see opportunities for the NHS, local authority, third sector and other partners to work more closely together e.g. ensuring timely discharge from hospital to home with a package of care and support in place.
People feel we could use digital options to provide more care at home or close to home, whilst also highlighting there is a need for education in the use of digital tools, and that some people prefer not to use them.
Staff and resources
People are concerned about the number of staff available in Powys and whether we can continue to offer services safely and effectively, and what more can be done to train, recruit and retain the future workforce given the reducing number of people of working age.
People ask whether more funding could be provided to the NHS in Powys, and whether public resources could be used more effectively.
Mental health should be a priority
People consistently identified mental health services as an important area for improvement. They highlighted earlier support, easier access, improved crisis services, better integration with physical health, and more person-centred care.
What we heard from NHS staff
We have heard similar feedback from NHS staff. While staff work in different roles and locations, several clear themes have emerged consistently.
Long-term sustainability of current services
Staff told us they feel pressure from increasing demand and the challenges of delivering services across a large rural county. Recruitment and retention difficulties, reliance on temporary staffing and challenges maintaining safe staffing levels were recurring themes. Staff generally felt that continuing to provide services in the same way would become increasingly difficult over time.
Better connected services
A common message was that services can sometimes feel fragmented, making it difficult for patients to move smoothly between different parts of the system. Staff told us they wanted stronger links between physical health and mental health – and also with social care, primary care and voluntary sector services – with more coordinated care and clearer pathways for patients.
More care at home and closer to home
Many staff described the benefits of strengthening community services wherever possible. There was support for developing integrated community hubs, improving services delivered in people's homes and communities, and reducing the need for people to travel unnecessarily for care and support in community hospitals or outside the county.
Greater focus on prevention and early support
Staff consistently highlighted the importance of helping people earlier, before their health needs become more serious or reach crisis point. This included both physical and mental health. They supported a shift towards prevention, early intervention and helping people to stay well and independent for longer.
Challenges of the Powys geography
Staff told us that long travel distances, transport difficulties and variation in access to services across the county can affect both patients and staff. They stressed the importance of designing future services in a way that recognises the realities of rural life. They were concerned about the impact for staff who do not have access to transport if roles and services change.
Using skills to shape the future
Staff told us there are opportunities to use their skills in better ways to meet the needs of patients, and also that any changes would need to be supported by a clear plan for staff development, training and education to ensure the skills and roles needed for the future.
Overall, our staff have consistently highlighted the need for changes that improve sustainability, strengthen local services, support the workforce, and provide more joined-up care for people across Powys.
What happens if services don’t change?
We know that any discussion about changing health services can be worrying. However, one of the most important things we have considered is whether services should simply stay as they are. After carefully reviewing the evidence, we do not believe that services can stay as they are, as this would not meet the future needs of people in Powys.
Doing nothing would mean accepting a future in which demand for health care services continues to grow while the ability to provide those services becomes ever more fragile. Powys has an ageing population, increasing levels of frailty, rising demand for mental health support and growing complexity of need. Without change, the gap between what local services are asked to provide and what they are able to deliver is likely to widen. The current model was developed around historic patterns of care, rather than the future needs of local people.
There are also challenges in recruiting and retaining staff in some services. In a rural county such as Powys, some services depend on a small number of specialist staff, making them more vulnerable if vacancies arise. Without changes to the way services are organised and delivered, maintaining safe and reliable local services may become increasingly difficult in some areas.
At the same time, the cost of delivering health care continues to rise. Simply spending more money on the current model would not necessarily improve services or outcomes. We need to ensure that available resources are used in the best possible way, focusing on prevention, earlier intervention and helping people remain independent for longer.
Most importantly, doing nothing would not address the challenges people have told us about, including difficulties accessing some services, variations in care across Powys and the need for better joined-up support closer to home. Without change, more people may need to travel outside Powys for treatment, and some local services could become harder to sustain in the future.
Further information
Our Case For Change has been based on insights from thousands of patients, residents, staff and partner organisations. We believe, based on the available evidence, that “no change” is not an option. But it is important for us to hear from you if important factors have not been considered.
You can read the Case For Change, and detailed Technical Chapters on issues such as Community Services and Mental Health, in the Supporting Documents section of our website.
How this engagement has shaped proposals for the future
The engagement process has directly influenced the proposals presented in this consultation.
In response to what people told us, the proposals place a strong emphasis on:
- Prevention.
- Care closer to home.
- Community services.
- Joined-up physical and mental health care.
- Reducing avoidable hospital admissions.
- Improving coordination between services.
- Considering transport and access impacts.
The next chapter explains how this feedback has helped us develop a vision for the future of health care in Powys, and later in this document you can read about our detailed proposals for adult physical health community and inpatient services, urgent care and diagnostics, and adult mental health community and inpatient services.