Health board considers biggest service shake-up for a generation

Health services in Powys could face their biggest shake-up in a generation, with proposals to cut community hospital beds and concentrate services at fewer sites.

There could be a reduction in the number of community hospital beds from 146 to either 90 across three hospitals or 60 across two.

A consultation could also bring changes to the location of local urgent care centres and minor injury and illness units, while a separate proposal would bring all mental health inpatient beds together on a single site.

It will begin on 5 October and run for 14 weeks until 10 January 2027, with a meeting taking place on Wednesday.

Under the options being considered, inpatient wards would be retained in Brecon and Newtown, with Llandrindod Wells potentially remaining open under the three-site model.

Beds could be lost at Welshpool, Machynlleth, Ystradgynlais and Llanidloes, as well as Llandrindod Wells under the two-site option.

The changes are part of Powys Teaching Health Board's Better Together programme with the health board saying that action is needed to "make services safe and sustainable" as demand for care increases.

Changes are needed to respond to "major challenges facing health services" at a time of rising demand, when people are living longer often with many long-term health conditions, it said.

Powys also has one of the oldest populations in Wales, with more than a quarter of the population over 65.

It is also becoming increasingly difficult for the health board to recruit and retain staff with the skills it needs, while delivering services in a large, rural county is also challenging.

According to the health board's analysis, the proposals would mean longer journeys for some patients with the average travel time to inpatient care rising from about 12 minutes to 24 minutes.

For people living furthest from the remaining hospitals, average journey times would be more than 45 minutes each way.

Dr Carl Cooper, who is Chairman of Powys Teaching Health Board, said the consultation would allow people to "test the evidence, challenge our thinking, and help inform what happens next".

"Our responsibility is to consider whether the evidence, options and supporting information are sufficiently developed to progress to this important next step," he added.

Under its Better Together programme the health board is proposing changes to services in a range of areas – adult physical health, adult mental health, urgent care and some diagnostic services.

Among the proposed changes, the most controversial could affect inpatient beds in most of Powys' community hospitals where occupancy rates are usually around 85 to 90%.

Powys doesn't have a general hospital, but it does have beds in eight community hospitals.

According to a report to the health board the current model "provides valued local services, but its dispersed configuration makes it increasingly difficult to meet needs consistently."

It will consult on two possible options:

• The first option would see beds located in three community hospitals in Brecon, Newtown and Llandrindod Wells. This would mean a reduction from 146 to around 90 inpatient beds for the whole of Powys.

• The second option would see beds located in two community hospitals in Brecon and Newtown. This would mean a reduction to around 60 inpatient beds.

Any changes would happen over a number of years.

A health board report said about 40% of its budget is spent on services commissioned from outside of Powys – in the last financial year this was around £198m.

There are also proposed changes to Powys' minor injuries units and the way urgent care is delivered in the county.

At the moment, urgent care is delivered in a variety of ways including by GPs, an out of hours service, pharmacies and health board minor injuries units.

But the health board believes the current service "does not provide consistent or equitable access across the county" and demand for urgent care is increasing.

Its is proposing two options for changes to urgent care and diagnostic services.

The first option would see urgent care available on three sites – Urgent Care Centres (UCCs) would be established in Newtown and Brecon, and a minor injuries unit in Llandrindod Wells, operating from eight in the morning until eight at night, seven days a week.

The minor injury unit would stay in Welshpool until the UCC opens in Newtown, and then the minor injury unit in Welshpool would close.

The second option would see just two UCCs in Newtown and Brecon.

According to the health board patients would benefit from the changes by having "improved access to a broader urgent care offer within Powys".

One option for changes to mental health services is proposed – the consolidation of all adult and older adult mental health services at a single site, either at Bronllys hospital or a new site in the Bronllys/Brecon area, as well as expanding community mental health services.

The plans have been met by strong political opposition with arguments that the consultation does not offer a genuine alternative to centralising services, as both options involve the closure of inpatient beds in several communities.

Plaid Cymru has called for the proposed consultation to be paused, arguing that communities are not being offered a meaningful enough choice over the future of local health services.

All options involve reducing hospital-based provision and concentrating services on fewer sites, they say.

Figures revealed by the Welsh Liberal Democrats show that Powys hospital beds were 91% full on average across 2025 and they describe the proposals as a choice between "two different versions of sweeping cuts".

Welsh Liberal Democrat Senedd member Jane Dodds called the plans a "shocking betrayal of public trust" and urged the Welsh government to intervene.