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• Issues Paper

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  Seeking your views on proposed temporary changes to health services in Powys

  This Issues Paper explains why Powys Teaching Health Board is proposing temporary changes to the following services:

  • Minor Injury Unit Opening Times in Brecon and Llandrindod Wells
  • Community Hospital inpatient services across Powys

  These proposed temporary changes would take place in the Autumn 2024.

  We are seeking your views on these temporary changes from 29 July 2024 to 8 September 2024.

  This is part of an ongoing conversation with the people of Powys to ensure that NHS services are safe and sustainable for the future.

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  Summary

  
  

  This section of the document summarises the proposed temporary changes to services provided by Powys Teaching Health Board.

  More information about the reasons for these temporary changes can be found in Section 1.

  
  

  Minor Injury Opening Hours

  We are proposing the following changes to opening hours.

  
  

  Unit	Current Opening Hours	Future Opening Hours
  Brecon	24 hours Seven days a week	8am to 8pm Seven days a week
  Llandrindod Wells	7am to Midnight Seven days a week	8am to 8pm Seven days a week
  Welshpool (no change)	8am to 8pm Seven days a week	8am to 8pm Seven days a week
  Ystradgynlais (no change)	8.30am to 4pm Mon-Fri except bank holidays	8.30am to 4pm Mon-Fri except bank holidays

  More information about the proposed temporary changes to Minor Injury Units can be found in Section 2.

  
  

  Community Hospital inpatient services

  We propose that each hospital will have a more focused role to help us provide the best care within the county. More information about the proposed temporary changes to Community Hospital inpatient services can be found in Section 3.

  
  

  Have Your Say

  These proposals would be put in place on a temporary basis to help us address the issues set out in this document. Given these challenges we may need to consider further temporary changes whilst we work with you to ensure that NHS services are safe and sustainable for the future. More information about the next steps can be found in Section 4.

  If approved, we would expect these temporary changes to be in place for at least six months. We are seeking your views from 29 July 2024 to 8 September 2024.

  It is important that anyone with an interest in NHS services in Powys has an opportunity to find out more about these issues and to let us know their views. Find out more about how to share your feedback in Section 5.

  
  

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  Section 1: Background

  
  

  About Powys Teaching Health Board

  Powys Teaching Health Board (PTHB) is responsible for providing and commissioning services for the people of Powys.

  We provide services within Powys where it is safe and clinically appropriate to do so. This includes community health services (e.g. health visiting, district nursing, dementia home treatment teams), community hospital services (e.g. outpatient clinics, ward-based services) and our partnerships with local primary care providers (general practices, pharmacists, dentists, optometrists).

  Due to the rural nature of Powys, more specialist services including district general hospital services are commissioned for Powys residents by neighbouring health boards in Wales and neighbouring NHS Trusts in England.

  More information about the structure of the NHS in Wales is available from the NHS Wales website.

  
  

  What is the long term vision for health and care in Powys?

  Working with patients, the public, staff and partner organisation we have developed a compelling long term vision for health and care set out in the joint Health and Care Strategy for Powys.

  We remain fully committed to this long term vision, and we will continue to work with you to deliver this.

  But the COVID pandemic meant that delivery of our vision has been slower than we need to address the challenges of the future. This means we need to act now to help us:

  • Live within our means without building up greater financial challenges for the future
  • Provide the best care for all our patients
  • Ensure that our services are safe and sustainable
  • Adapt quickly to meet the challenges we are currently facing
  • Work more effectively and efficiently
  • Respond to pressures on staffing and budgets

  Earlier this year we began a conversation across Powys, with events in each of the 13 Powys localities, to discuss the challenges we face and listen to your views about how to respond to this.

  You can find out more about these conversations which we called "Better Together" here.

  We plan to return to communities across Powys to continue these conversations this Autumn. This is part of our commitment to work with you to agree the right shape of health services for the long term.

  But, in the meantime we need to propose the temporary changes set out in Section 2 and Section 3, as well as consider further changes we may need to take on a temporary basis.

  
  

  What challenges is the NHS facing?

  
  

  Last year the NHS marked its 75^th birthday.

  But too many parts of the NHS are designed based on the needs of the past, rather than the opportunities of now and the future.

  We need to focus now on building a renewed NHS that we can all be proud of when it reaches its 100^th birthday. It needs to reflect the realities of life in Powys now. It needs to look ahead to the right way to deliver the best care over the next 10-25 years.

  Some of these challenges facing the NHS across the UK include:

  • More people are living longer with multiple health conditions, which increases the demand for health services.
  • The NHS is still recovering from a once-in-a-century pandemic, and we have backlogs in treatment, pressures on ambulances and emergency departments, and people delayed in hospital.
  • Cost of living and inflationary pressures have affected how we respond. For example, there has been a significant rise in energy bills.
  • There are growing pressures on the NHS workforce with increasing reliance on expensive agency staffing.

  And specifically, here in Powys:

  • A third of people in Powys live alone: loneliness can increase ill health and is a key reason people seek help from health and care services.
  • Cancer, respiratory conditions, circulatory diseases, and mental ill health continue to be the “big four” reasons for ill health in Powys.
  • The population in Powys is older than the national average and the proportion of people of working age is reducing faster than other parts of the UK.

  Together these issues are also having a major impact on the public purse. In Powys we receive a budget of approximately £400 million per year to provide and commission hospital healthcare services. But in 2024/25 we expect to end the year with a deficit of over £20m. It is essential that we take steps to live within our means so that we do not store up even bigger financial problems for future years.

  At the heart of our approach to financial sustainability is a relentless focus on efficient administration and management functions. Our core mission is to provide and commission safe services that offer the best outcomes for patients. “Back office” services need to be lean and efficient so that clinical staff are empowered and enabled to deliver the services you need.

  However, given the clinical, operational, and financial challenges faced by our health care services we do need to take steps to deliver these services more efficiently including reducing the amount of money we spend on agency staffing.

  We have therefore looked very carefully at some temporary changes that help us:

  • Continue to deliver the services that matter to you
  • Work more effectively and efficiently so that we live within our means
  • Make best use of our staff, who are our most valued and valuable resource.

  The purpose of this engagement is:

  • To let you know about the proposed temporary changes and why they are taking place.
  • To seek your feedback
  • To invite you to be part of the conversation about the long-term shape of health services for the people of Powys.

  You can find out more about the temporary changes we are proposing in Section 2 and Section 3.

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  Section 2: Temporary Changes to Opening Hours of Minor Injury Units

  
  

  These proposed temporary changes affect the opening hours of the Minor Injury Units in Brecon and Llandrindod Wells. They do not affect the opening hours of Minor Injury Units in other Powys hospitals, minor injury services provided by GP practices, or minor injury services outside Powys.

  
  

  About PTHB Minor Injury Units

  
  

  Powys Teaching Health Board directly provides four Minor Injury Units. These are in our community hospitals in Brecon, Llandrindod Wells, Welshpool and Ystradgynlais.

  These are run by specially trained Emergency Nurse Practitioners (ENPs).

  They offer care treatment for minor injuries such as cuts and sprains to adults and to children aged 2+.

  The current opening hours are:

  Brecon	Llandrindod Wells	Welshpool	Ystradgynlais
  24 hours	7am to midnight	8am to 8pm	8:30am to 4pm
  Every day	Every day	Every day	Monday – Friday (excl. Bank Holidays)

  From Autumn 2024 there will be a temporary change in opening hours:

  Brecon	Llandrindod Wells	Welshpool	Ystradgynlais
  Changed	Changed	Unchanged	Unchanged
  8am to 8pm	8am to 8pm	8am to 8pm	8:30am to 4pm
  Every day	Every day	Every day	Monday – Friday (excl. Bank Holidays)

  
  

  Why are these temporary changes to opening hours being proposed?

  
  

  Our minor injury unit services face several challenges:

  • On average, our minor injury units in Brecon and Llandrindod Wells see just one or two people per night. This is not a good use of public resources or of the specialist skills of the Emergency Nurse Practitioners who provide these services.
  • Nearly all patients who attend overnight could or should attend during the day. For example, we are not able to offer a 24-hour x-ray service so patients needing an x-ray need to come back during the day.
  • It is difficult to recruit and retain sufficient Emergency Nurse Practitioners to run the current opening hours.
  • Because we cannot always find staff with the right skills, we sometimes need to close a Minor Injury Unit at short notice. This is a growing problem. Between January and May there were over 50 occasions when a Powys Minor Injury Unit needed to close in the evening or overnight because of staffing issues. This means that we are not able to provide a reliable service.
  • We estimate that an attendance during the day at a Minor Injury Unit in Powys costs between £60 and £85. Given the low number of attendances overnight, a nighttime attendance costs around five times as much (£340).

  We are proposing these temporary changes so that the service is safer and more reliable:

  • Offer more reliable opening times and reduce the number of unplanned closures.
  • No “lone working” out of hours. This is safer for staff, and safer for patients.
  • Encourage more people to “phone first” wherever possible. This means that our specially trained staff can assess your needs over the phone, provide advice on first aid and self-care, book a slot that is convenient to you, or direct you to a more appropriate service.

  There will also be some temporary changes to staffing in all the health board’s minor injury units so that it has better alignment with service activity and demand.

  Making these temporary changes would help us stabilise the service, and allow us to work with you to make plans for the future.

  
  

  What would happen during the hours of closure?

  Currently around one patient per night visits the MIU in Brecon and the MIU in Llandrindod after 8pm.

  Minor injury units do not provide treatment for life or limb threatening injuries. The MIUs in Powys are not able to provide x-ray overnight to assess whether a bone may be broken. They either ask patients to return during the day or on rare occasions refer them to emergency departments if their injury is serious.

  Nearly all patients who attend PTHB Minor Injury Units after 8pm could be seen during daytime hours or are already being referred by the Unit to self-care or to other services.

  
  

  What Happens Now?	What would happen if the temporary changes were in place?
  Emyr had an operation recently. The local Minor Injury Unit is a convenient place to have his wound dressing changed rather than visiting his GP practice. He visits at 6am because he is normally awake early.	Emyr would be able to have his wound dressing changed during daytime hours.
  Marjory has tripped on the stairs at 11pm and is concerned that she may have fractured her ankle. She visits the MIU. They provide self-care advice and ask her to return in the morning when x-ray services are available.	Marjory rings 111 for telephone advice. A 111 clinician provides a telephone assessment. Based on this telephone assessment Marjory receives self-care advice and is advised to visit the MIU in the morning when x-ray services are available. She is saved a potentially unnecessary visit to MIU at night (when x-ray is not available) and is given clinical advice on self-care in her own home.

  Other services available overnight include:

  • Always call 999 for life and limb threatening illnesses and injuries.
  • NHS 111 Wales has an online symptom checker at 111.wales.nhs.uk for advice and treatment of common conditions.
  • NHS 111 Wales offers a free 24-hour telephone service providing urgent care advice, including access to out of hours GP services for illnesses that cannot wait until the GP practice is next open.
  • If the problem is more serious, residents may be advised to see their local doctor (including GP out of hours services if appropriate) or go to their nearest major hospital emergency department (“A&E”). NHS 111 Wales advisers can also call an ambulance on a patient’s behalf if required.
  • Keep a well-stocked medicine cabinet for minor illnesses and injuries. Your local high street pharmacist can recommend the essentials or check the NHS 111 Wales website at 111.wales.nhs.uk/livewell/medicinecabinet

  We welcome your views on other steps we could take if these temporary changes were implemented.

  
  

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  Section 3: Community Hospital inpatient services across Powys

  
  

  These proposed temporary changes affect the general medical wards in our community hospitals in Powys.

  
  

  Powys Teaching Health Board currently has over 150 general medical inpatient beds across nine wards in eight community hospitals:

  • Breconshire War Memorial Hospital: Epynt Ward and Y Bannau Ward
  • Bro Ddyfi Community Hospital (Machynlleth): Twymyn Ward
  • Bronllys Community Hospital: Llewelyn Ward
  • Llandrindod Wells Memorial Hospital: Claerwen Ward
  • Llanidloes Community Hospital: Graham Davies Ward
  • Montgomery County Infirmary (Newtown): Brynheulog Ward
  • Victoria Memorial Hospital (Welshpool): Maldwyn Ward
  • Ystradgynlais Community Hospital: Adelina Patti Ward

  In addition:

  • Panpwnton Ward at Knighton Hospital temporarily closed during the COVID pandemic, and we have faced ongoing staffing challenges that mean we have not been able to re-open the ward. However, we have successfully introduced a short stay reablement care facility in a residential care environment at the hospital on a temporary basis.
  • Glan Irfon Health and Social Care Centre in Builth Wells offers short stay reablement in a residential care environment.

  These wards provide care for patients with a wide range of medical needs that require inpatient nursing care (e.g. palliative care, inpatient rehabilitation for conditions other than stroke). Currently a patient whose clinical needs are suitable for a community hospital environment will be admitted to their most local community hospital if a bed is available. The main exception is inpatient stroke rehabilitation which requires specialist skills and expertise and is therefore provided at Brecon and Newtown.

  For a temporary period, we are proposing the introduction of a more specialised focus for some of the wards in our hospitals:

  • Two hospital wards would be designated as our “Ready To Go Home” units. These would provide focused care and support for patients who are ready to return home but are waiting for a package of community care. They would be located at Llanidloes Community Hospital and Bronllys Community Hospital. This is alongside the continued role of Glan Irfon and Knighton.
  • Two hospital wards would have an enhanced specialist role to support patients who require inpatient rehabilitation. This will build on the existing arrangements for stroke rehabilitation. So, they would be located at Breconshire War Memorial Hospital and Montgomery County Infirmary (Newtown).
  • Our other hospital wards (Ystradgynlais, Llandrindod Wells, Welshpool and Machynlleth) would continue to operate as general medical wards. Some patients who would currently receive care on these wards would instead receive their care in Bronllys or Llanidloes (e.g. if they are "ready to go home") or in Brecon or Newtown (if they require more intensive rehabilitation).

  Why are these temporary changes being proposed?

  Our general inpatient wards face several challenges.

  
  

  Patient Quality and Outcomes	Patients are spending longer in community hospitals than they should. One reason is because they are waiting for packages of care in the community to support them to go home (including to a care home). If people spend too long in a hospital bed it can lead to “deconditioning”: they can lose their muscle strength, ability to care for themselves and also become disoriented. This can make it harder to return home, and it can increase the likelihood of readmission to hospital. We need to break this cycle and support people to go home as quickly as possible.
  Specialist Staffing	The rural nature of Powys means that our specialist skills are spread thinly across the county. There are benefits in bringing patients with the same needs together and concentrating our specialist staff in these locations, rather than skilled staff spending a lot of time travelling between different hospitals.
  Finance	In common with other services, we face challenges in recruiting and retaining skilled staff. We have a high dependency on agency staff which is extremely expensive for the public purse. The proposed changes should reduce our reliance on agency and temporary staff who, in addition to being more expensive, are often unfamiliar with the wards and the patients, potentially leading to reduced quality of care.

  What would these temporary changes mean for patients?

  These proposals aim to reduce unnecessary time in hospital, so that patients can return home (including to a care home) more quickly. They also aim to keep those patients that are ready to go home more active and reduce the chances of deconditioning.

  Our dedicated inpatient rehabilitation units would be able to offer more patients more reliable access to the additional support they need in order to return home. They also aim to help more patients return more quickly to Powys when they no longer need district general hospital care outside the county.

  But, for some patients it would mean that rather than being admitted to their most local hospital they would instead receive their care in a community hospital with the specialised focus of care that best meets their needs.

  For example, under the proposal, patients who are “Ready To Go Home” but do not yet have a package of community care may receive their care in Llanidloes Hospital or Bronllys Hospital, as well as in the current reablement units in Knighton and Builth Wells. Whereas patients needing more specialist inpatient rehabilitation may receive their care in Newtown Hospital or Brecon Hospital.

  We know how important visits are to patients and families. Visiting hours are and will remain flexible under the proposal, with family members able to visit at times that best suit them. For example, if you ring ahead our ward staff will accommodate as many requests as possible to support patient well-being. We are also continuing to strengthen alternatives to visiting including helping you stay in touch through digital technologies.

  
  

  What Happens Now?	What happens if the proposed temporary changes are in place?
  Eirlys is 86. She has been receiving care in Royal Shrewsbury Hospital following a urinary tract infection. She has been assessed as ready to go home but a package of community care is not yet in place. She is temporarily admitted to her nearest community hospital in Newtown until a community care package is place. She is cared for alongside patients with a wide range of different health conditions from palliative care to dementia. She spends 35 days in hospital, and during this time she experiences deconditioning which makes it harder to return to her level of functioning before she was admitted to the Royal Shrewsbury Hospital.	Eirlys is admitted to the Ready to go Home Unit in Llanidloes rather than to Newtown, where she receives support dedicated to her specific needs. This enables her to maintain her independence, reduces the likelihood of deconditioning, and supports her to return home as quickly as possible. These are proposed temporary changes: the longer term plan is that Eirlys would go straight home from Royal Shrewsbury Hospital without a further stay in a community hospital.
  Gareth is 78. He has recently had an operation for a fractured hip in Swansea and needs further rehabilitation and support in a community hospital before he is ready to return home. He is admitted to his nearest community hospital in Ystradgynlais where he is cared for alongside patients with a wide range of different health conditions from palliative care to dementia. Whilst the rehabilitation he receives is of a good quality, the frequency of visits by expert staff is not optimal which means he does not return home as quickly as he could.	Gareth is admitted to Breconshire War Memorial Hospital for his rehabilitation, where he receives a comprehensive programme of inpatient rehabilitation from a highly skilled multidisciplinary team that supports him to return home as quickly as possible. This helps him to return to his previous level of independence and activity and reduces the likelihood of readmission to hospital and reduces the need for ongoing care and support.

  
  

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  Section 4: Next Steps

  
  

  Proposed Temporary Changes to Health Services in 2024/25

  This document explains some proposed temporary changes to Minor Injury Units and community hospital inpatient wards that would come into effect in the Autumn. Given the clinical and staffing difficulties set out in this document we may also need to consider temporary changes in other service areas. If temporary changes are needed, then we will make sure that proposals are shared with you so you can give your views.

  We also want to take this opportunity to inform you of some forthcoming improvements to x-ray equipment in Brecon, Llandrindod Wells, Newtown, Welshpool and Ystradgynlais. Over the coming months we will be replacing the x-ray facilities at these sites with new equipment. This will be delivered through a rolling programme, with each site temporarily closed for x-ray services whilst this works takes place. Please accept our apologies in advance for any inconvenience during these essential works.

  A Safe and Sustainable Future

  We want to work with you to agree the long term shape of health services in Powys.

  We have already worked with patients, the public, staff and partner organisations across Powys to develop the long term vision for health and care set out in the joint Health and Care Strategy for Powys.

  We have also begun a conversation about the future of health care in the county. Earlier this year we worked in partnership with Powys County Council to visit each of the 13 Powys localities, to discuss the challenges we face and listen to your views. You can find out more about these conversations. See our Important Links (right)

  Later this year we will be coming back out to communities across Powys to build on the ideas that you have already shared. This will help us to develop a clear plan that makes best use of all the skills and resources in Powys to ensure that health services are safe and sustainable for the future. You can stay involved in this work by signing up for our regular newsletters.

  
  

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  Section 5: Have Your Say

  
  

  This document provides information about proposed temporary changes to health services in Powys from Autumn 2024. We expect these to be in place for at least six months.

  It is important that anyone with an interest in NHS services in Powys has an opportunity to find out more about these issues and to let us know their views.

  If you would like to share your comments about these proposed temporary changes – including any specific ways in which they may impact on people based on equality protected characteristics, Welsh Language, socio-economic status, or carer responsibilities – please contact us by 8 September 2024. This is part of an ongoing conversation with the people of Powys to ensure that NHS services are safe and sustainable for the future.

  Find out more online: Visit our engagement website and complete our online survey here

  Attend an online event: Information about our online events is available on the home page.

  By telephone: You can also request a copy of this document by calling our answerphone on 01874 442078. Just leave a message with your name and postal address, spelling any unusual words.

  In writing: If you do not have access to the internet, you can also share your views in writing to PTHB Engagement and Communication Team, Glasbury House, Bronllys Hospital, Bronllys, Brecon LD3 0LY.

  What will happen after the engagement period?

  The views you share will contribute to an engagement report which will be discussed at a meeting in public of the Board of Powys Teaching Health Board. We will also ensure that your feedback is shared with Llais, the Citizen Voice Body for Health and Social Care in Wales, to help them represent the views of patients and the public. You can find out more about Llais from their website. We will publish the feedback we received on this website.

  We would also like to engage with you as part of a longer term conversation from Autumn 2024 to ensure that NHS services are safe and sustainable for the future. You can stay involved in this work by signing up for our regular newsletters.

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

  
  

• Your Questions Answered

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  Last updated 14 August 2024

  The “Your Questions Answered” page is regularly updated to respond to questions you are raising with us.

  
  

  Q. What are the 13 Powys Localities?

  Powys is a large county with around 133,000 residents across an area of around 2000 square miles. Public sector organisations in Powys therefore plan our services based on 13 locality areas. Each locality area centres around the largest towns in Powys and their surrounding areas.

  This approach helps us to make sure that we are understanding and responding to local needs within each locality, whilst also planning on a whole county basis.

  The thirteen localities are:

  • Brecon Locality
  • Builth and Llanwrtyd Locality
  • Crickhowell Locality
  • Hay and Talgarth Locality
  • Knighton and Presteigne Locality
  • Llandrindod and Rhayader Locality
  • Llanfair Caereinion Locality
  • Llanfyllin Locality
  • Llanidloes Locality
  • Machynlleth Locality
  • Newtown Locality
  • Welshpool and Montgomery Locality
  • Ystradgynlais Locality

  
  

  Q. How can I find out more about health and wellbeing in Powys?

  The following documents provide useful information about health and wellbeing in Powys:

  • Powys Population Needs Assessment 2022
  • Powys Wellbeing Assessment 2022
  • Powys Teaching Health Board Integrated Plan 2024-2029
  • Joint Health and Care Strategy for Powys 2017-2027.

  
  

  
  

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  Proposed Temporary Changes to Minor Injury Units

  
  

  Q. What steps is the health board taking to reduce the likelihood that people will attend when the units are closed?

  Between January and May there were over 50 occasions when a Powys Minor Injury Unit needed to close in the evening or overnight because of staffing, sometimes at very short notice. This means that we are already needing to communicate regularly about changes to opening hours including via our website and social media channels.

  We will build on the arrangements that are already in place and in addition:

  • This period of engagement is an opportunity to raise awareness of proposals to change MIU opening hours.
  • The proposed temporary hours would be more reliable and less subject to change.
  • The three MIUs in Brecon, Llandrindod Wells and Welshpool would operate the same hours which would provide a more consistent service.
  • We would continue to promote the services available from NHS 111 Wales.
  • We would ensure that there is clear signage at the Minor Injury Units to advise people of alternative services.
  • We would encourage people to “phone first” for MIU wherever possible. During opening hours our emergency nurse practitioners can provide immediate telephone advice, book patients an appointment, or advise of an alternative service to save an unnecessary visit. If a MIU is closed there will be an answerphone message to explain the opening hours and direct people to 111.
  • We would continue to issue weekly social media posts with MIU opening times for the week ahead.
  • We would continue to promote the Help Us Help You campaign which includes messages about stocking up your medicine cabinet, advice from your pharmacy, and the wider range of services available in local communities and online.

  Q. What services do PTHB Minor Injury Units provide?

  Minor Injury Units treat burns and cuts, they provide dressings and repeat dressings, and they can arrange for x-rays to be taken (this is only available when the X-ray facility is open).

  Minor Injury Units in Powys can treat people aged 2 and over.

  Here are some the reasons why people attend an MIU in Powys:

  • Back injury
  • Bite or sting (including insect, animal and human bites)
  • Minor burns or scalds
  • Emergency contraception
  • Minor eye, ear or nose injuries, including foreign bodies
  • Simple fractures
  • Sprains and strains
  • Cuts, wounds and lacerations.

  Q. When should I go to an Emergency Department (“A&E”) at a major hospital or dial 999?

  Dial 999 or go to A&E for life and limb-threatening illness and injuries including:

  • Choking
  • Chest Pain
  • Blacking Out
  • Blood Loss
  • Serious Injury
  • Suspected Stroke

  Q. Do GP practices offer Minor Injury Services?

  Minor injuries is not part of the core General Medical Services contract with General Practices. But in Powys in many of the localities where PTHB does not have a Minor Injury Unit we have a contract in place with the GP practice to provide a local minor injury service.

  These services are not affected by the proposed changes outlined in this document.

  Check with your General Practice to find out what services they provide.

  Q. What other options have been considered before making this proposal?

  We have considered alternative staffing models, but no viable options have been identified. MIUs need to be run by staff with specialist skills, and in Powys this is by skilled Emergency Nurse Practitioners.

  Also, given the very low number of attendances at MIU overnight it is difficult to identify feasible options that offer good value to the public purse.

  Q. Why do MIUs have different opening times?

  Previously the MIUs in Brecon, Llandrindod Wells and Welshpool were open 24 hours a day.

  Llandrindod Wells temporarily reduced its hours because of staffing challenges. Welshpool temporarily reduced its hours because of the risk of cross-infection of COVID: the nurse working in MIU overnight also worked on the ward, so this created an infection risk for vulnerable inpatients if the nurse was also treating patients in MIU.

  As part of our ongoing conversation about health services we will work with you to decide the permanent opening hours for MIUs in future.

  Q. When will the new x-ray facilities be installed?

  The dates for the installation of new x-ray facilities in Brecon, Llandrindod Wells, Newtown, Welshpool and Ystradgynlais have not yet been confirmed. Look out for more details later this year.

  Please accept our apologies for any inconvenience whilst these essential improvement works take place.

  Q. What happens next?

  The views you share will contribute to an engagement report which will be discussed at a meeting in public of the Board of Powys Teaching Health Board before decisions are made.

  We would also like to engage with you as part of a longer term conversation from Autumn 2024 to ensure that NHS services are safe and sustainable for the future.

  Q. Would this proposal affect how Shropdoc GP Out of Hours operates?

  No. Shropdoc GP Out of Hours would not be affected.

  Q. How many people attend MIU during the hours you are proposing to close?

  Between April 2023 and March 2024:

  • Brecon MIU saw an average of 25.0 patients per day during the day (between 8am and 8pm) and 1.4 patients overnight (one patient every 8.5 hours between 8pm and 8am)

  • Llandrindod Wells MIU saw an average of 17.3 patients per day during the day (1.4 per hour between 8am and 8pm) and 0.9 patients out of hours (one patient every 5.5 hours after 8pm / before 8am)

  • Welshpool MIU saw an average of 13.4 patients per day (1.1 per hour) and is not open overnight

  • Ystradgynlais MIU saw an average of 7.4 patients per day (1 per hour) and is not open overnight

  Q. What would the impact on neighbouring A&Es be?

  Conversations with our neighbouring hospitals have taken place and based on the low numbers of patients attending our MIUs overnight they have assured us that this proposal would not cause any undue extra pressure.
  

  On average there is less than one attendance per night overnight at Llandrindod Wells MIU and 1-2 attendances at Brecon MIU overnight. The majority of these could be seen when the MIU next opens. This is because MIUs see people with low to moderate injuries.

  If a MIU is not open then NHS 111 is here for urgent care advice. There are handy symptom checkers available online at https://111.wales.nhs.uk and 111 is available to phone free 24 hours per day. This is an excellent source of advice on self-care and first aid, as well as assessing whether a patient has needs that need to be met straight away. As now, people with more significant injuries cannot be treated in MIU and would continue to be referred to A&E.

  Q. What should I do if MIU is not open?

  As now, when a MIU is not open then NHS 111 is here for urgent care advice. There are handy symptom checkers available online at https://111.wales.nhs.uk and 111 is available to phone free 24 hours per day. This is an excellent source of advice on self-care and first aid, as well as assessing whether a patient has needs that need to be met straight away.

  For life and limb-threatening injuries, call 999 or go to A&E.

  
  

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  Community Hospital Inpatient Services

  
  

  Q. Would patients move to a different hospital?

  These proposals would only affect new patients being admitted to a community hospital in Powys.

  Patients already in a Powys hospital would normally remain in the same ward until they are discharged. But there may be benefits for the quality of care and outcomes for some patients to move to a different hospital. In these circumstances we would – as now – discuss these options with patients and families.

  Q. Would visiting hours change?

  Visiting hours are and would remain flexible with family members able to visit at times that best suit them. Most family members ring ahead of a visit and the ward staff accommodate as many requests as possible to support patient wellbeing.

  Q. What about family members who want to visit and will have longer to travel?

  This is potentially the biggest impact for some family members who wish to visit their loved one. It is likely that for some people the proposal would mean a shorter journey time and for others a longer journey time to get to the ward.

  We do recognise this and would provide digital options to enable family members to see and communicate with our patients at the touch of a button. We are investing in some kit to enable this as an option when travel is an issue.

  Traveline Cymru can provide bus routes and timetables to help this.

  Help may also be available from community transport services. More information about community transport in Powys is available from the Powys Association of Voluntary Organisations website. If you are having difficulty finding out about travel options then the Community Connectors service provided by Powys Association of Voluntary Organisations is here to help connect you with community organisations in your area.

  Q. Would there be job losses?

  There would be no job losses. We have struggled to recruit staff into these posts and have been talking to our nursing teams to find out their views and thoughts about the proposals. They recognise and are fully aware of the challenges we have been facing. We value all our staff and will continue to recruit where we need to do so.

  Q. Does this proposal mean that patients will be further away from home?

  Some patients may receive their community hospital inpatient care further from their home than is currently the case. But, they would be in a setting that has a more specialist focus on their needs. With enhanced rehabilitation it is expected that stays in hospital would become shorter. Fewer patients should experience delays in district general hospitals outside Powys waiting to return to the county.

  Q. What can happen to patients if they spend too long in hospital?

  There is clear evidence that for older adult populations, admission to hospital leads to deconditioning. Deconditioning is a complex process of physiological and psychological change following a period of inactivity, bedrest, or sedentary lifestyle. It can result in functional losses in mental status and impact the ability to perform daily living activities. This can be rapid, severe, and often irreversible:

  • Deconditioning can start within two days of hospital admission.
  • In the first seven days of admission, inpatients typically have reduced muscle strength by up to 10%, and circulation can reduce by up to 25%.
  • This can give patients reduced dignity, confidence, and independence.
  • It can make it more difficult for them to return to their normal level of functioning at home, and more likely to be readmitted to hospital

  Q. Would End of Life Care still be delivered in Llanidloes and Bronllys?

  Yes, dedicated short-term end of life care would still be available in both Llanidloes and Bronllys for those patients who have care needs. This would be for those patients needing additional care that can't be provided at home, in the last few days of life.

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  About the Engagement Process

  
  

  Q. How can I request a printed copy?

  We want to ensure that people in Powys have the opportunity to find out more and have their say. We also want to use public money wisely and reduce the impact on the environment – and this includes reducing the printing and distribution of paper copies which may not be read.

  We think that a cost effective and accessible approach is to send a printed copy of our engagement document to people who need one because they cannot access it online including from a local library or community hub.

  If you know someone who needs a printed copy of our engagement document, they can call our answerphone on 01874 442078. Just leave a message with their name and postal address, spelling any unusual words, and we will pop a copy in the post.