Your Questions Answered

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:

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.

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.

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.

The engagement has concluded