Discussion Paper

Executive Summary

Health services in Powys are facing significant challenges related to quality, workforce and long-term sustainability.

During 2024 we introduced a number of temporary changes to help us respond to these challenges whilst maintaining vital patient care. They were:

• A change to the opening hours (8am to 8pm) for the Minor Injury Units (MIUs) in Brecon and Llandrindod Wells.

• Implementation of two Ready to Go Home Units (RTGHUs) in Llanidloes and Bronllys in combination with strengthened inpatient rehabilitation at Brecon and Newtown.

We reviewed the temporary changes in July 2025. The temporary changes were delivering benefits for patient care, but we recognise the strength of public feeling about local community hospital services.

When we reviewed the temporary changes in July 2025, we had planned a period of formal consultation from Autumn 2025 looking at all the adult physical and mental health community services we provide across the county. This would help us to make decisions about the temporary changes.

These are complex issues, and we do not want to rush the decisions that need to be made. We now expect the formal consultation to take place next year.

In the meantime, the temporary changes will remain under review. This review process will look at quality, safety, outcomes and patient experience. It will also listen to the public and local stakeholders.

This discussion paper is part of that review. It provides an update on the temporary service changes introduced by Powys Teaching Health Board in December 2024 and seeks your views. It:

explains why the temporary changes were proposed,
summarises the engagement undertaken during Summer 2024 and what we heard,
sets out the decisions made by the Board in October 2024 and the implementation of the temporary changes, and
shares the work we have undertaken to review and evaluate the temporary changes
seeks your views by 15 February 2026

The Journey So Far

Spring 2024: Proposals for temporary changes to inpatient wards and minor injury units were put forward
Summer 2024: A period of engagement took place from 29 July to 8 September 2024
October 2024: The feedback from engagement was considered at a meeting in public of Powys Teaching Health Board on 10 October 2024. Following careful consideration of the balance of benefits and risks, the Board agreed to implement the temporary changes with a six-month evaluation in place.
July 2025: The findings from the six-month evaluation were reviewed at a meeting in public of Powys Teaching Health Board on 30 July 2025. The Board noted the benefits that were being achieved through the temporary changes and agreed that they should remain in place, with decisions on the permanent shape of services to be made through the Better Together programme. At that time, it was expected that formal consultation on Better Together proposals for adult physical and mental health community services would take place from Autumn 2025.
Autumn 2025: The health board has agreed that further work is needed on the Better Together programme and formal consultation is now expected next year. Any decisions on the future of individual wards or urgent care services need to be made as part of the “bigger picture” being developed through Better Together rather than as standalone proposals. Planning is under way for formal consultation during 2026/27. Alongside this vital work we are keeping the temporary service changes under review. We are seeking feedback from patients, staff, communities and stakeholders between November 2025 and February 2026.

Your feedback will contribute to the next review of the Temporary Service Changes in March 2026.

1. Our Minor Injury Units

In recent years our Minor Injury Units have frequently faced staffing issues, leading to last-minute closures. Providing a safe and sustainable service was very challenging overnight due to the very low number of people needing these services between the hours of 8pm to 8am. A key risk included the deskilling of specialist nurses due to the very low number of patients.

Nearly all minor injuries overnight that are suitable for treatment in our Minor Injury Units can either safely be seen when the unit next opens or need to be seen more quickly by an alternative service such as a hospital Accident & Emergency Department (for example, our Minor Injury Units do not offer x-ray services overnight).

2. Our hospital sites and inpatient beds

When we reviewed our hospital beds in 2024, we found that nearly half of patients were fit for discharge but waiting for onward care packages, home adaptations or assessments.

We identified that we could provide better, more person-centred care for our patients by designating some of our hospital wards as “Ready to Go Home Units” and some as “Rehabilitation Units”.

“Ready to Go Home Units” would enable us to work with patients who no longer needed community hospital care, supporting them to improve their independence allowing them to move around more, get up, get dressed, socialize, and take trips out with family members – all of which would support a faster discharge home.

Meanwhile, those patients who require more intensive rehabilitation in a community setting could be better supported in a specialist “Rehabilitation Unit” with all the relevant staff on site offering physiotherapy and care to enable that person to reach safe levels of independence and prepare for discharge home. This would build on the arrangements already in place I Powys for patients needing inpatient stroke rehabilitation.

We recommended these changes to:

ensure patients were better supported in an environment which would lead to a faster discharge and a return to independent living,
reduce “deconditioning”,
offer a more reliable service,
reduce staffing pressures, and
create a more reliable service for our communities.

Note: Deconditioning is where a person loses muscle tone quickly over a short period of time because they are less mobile than they normally are. This is often the case when someone is in hospital if they spend extended periods of time in in bed while receiving care and treatment.

Listening to your views in Summer 2024

A period of engagement on these proposals took place from 29 July to 8 September 2024.

We published an Issues Paper which explained why the health board was proposing the temporary changes. This was supported by additional information in a “Your Questions Answered” document, and a survey to gather views.

Feedback was also gathered through online webinars, the health board’s website, social media sites, posters placed in libraries and other local venues, information shared by the health board’s free e-newsletter, and attendance by health board representatives at public meetings.

In addition to the feedback, we heard through events and meetings, nearly 170 responses were received via our survey, letters and emails during the engagement period.

Feedback on the proposals for Minor Injury Units (MIUs)

During the engagement we heard a lot of misunderstanding about the conditions that can be treated in a Minor Injury Unit in Powys overnight. Our engagement document aimed to reinforce that these units are strictly for minor injuries only, and that x-ray services are not provided overnight. However, some people shared concerns about medical treatment of illnesses (which are not treated in MIUs) or for more serious injuries (which require treatment in a main A&E department or by ambulance paramedics).

We heard concerns about the impact reducing the overnight hours would have on local patients and communities needing treatment for minor injuries overnight. There were comments regarding travel distances to other hospitals, ambulance waiting times, and waiting times at A&Es if a person needed medical attention. People shared concerns about the ability to travel to A&E departments outside the county overnight, particularly those who do not have access to transport.

We also heard support of the proposal. There was recognition that the units had very low levels of use overnight, and that in many cases the conditions presenting overnight either could safely wait until the MIU next opened or would need to be treated in a hospital A&E department outside the county. Responses recognised that staff were under-utilised and risked being de-skilled, that services like 111 and 999 are available 24 hours a day to provide advice and guidance and direct people to appropriate treatment, and that ShropDoc GP Out of Hours services were not affected.

We heard valuable feedback from staff including on changes to the skill mix and staffing model across the county.

Feedback on the proposals for Ready to Go Home Units

We heard concerns from people in the Llanidloes and Bronllys areas about proposals to make temporary changes to the role of Graham Davies Ward in Llanidloes and Llewelyn Ward in Bronllys. This included:

additional travel to visit patients with clinical needs that could not be met in a Ready To Go Home Unit,
care for patients at end of life and the impact on palliative care units funded through public fundraising,
impact on the future role of the ward including whether the changes may become permanent,
whether patients may experience multiple transfers between hospitals and the impact this may have,
impact on staffing and skills including working together with GP practices to reduce the need for acute hospital admission.

We also heard support for the proposals including:

providing an environment that reduces deconditioning with a focus on supporting people who are ready to go home,
reducing delays in District General Hospital outside the county and bringing patients back into Powys more quickly,
supporting patients to return home more quickly as nursing and social care teams can work together in Ready To Go Home units to develop a package of care and support.

We heard valuable feedback from staff including overall impact on the staffing model and skill mix, and support to maintain skills for those staff working in Ready To Go Home Units.

Feedback on the proposed Rehabilitation Units

Feedback about the proposals to strengthen the role of the Rehabilitation Units was generally positive – although some respondents were not aware that Brecon and Newtown are already the designated centres for stroke rehabilitation, and that this proposal would build on existing arrangements.

Many respondents recognised the benefits in bringing together patients who required higher levels of rehabilitation in a community setting, so that the right levels of staffing and skills can be brought together to speed up their recovery. Some respondents wanted these services to be provided in every community hospital.

Consideration by the Board on 10 October 2024

The proposals for temporary service change were given conscientious consideration by the Board at a meeting in public on 10 October 2024.

The Board approved the following temporary service changes:

A change to the opening hours (8am to 8pm) for the Minor Injury Units (MIUs) in Brecon and Llandrindod Wells.
Implementation of two Ready to Go Home Units (RTGHUs) in Llanidloes and Bronllys in combination with strengthened inpatient rehabilitation at Brecon and Newtown.

This included a review of the potential benefits for the quality and outcomes of care, particularly in reducing delays for patients in district general hospitals outside the county and to reduce the risk of deconditioning. It is recognised the challenges for maintaining and appropriately skilled workforce in the minor injury units, the low levels of attendance overnight, and the risks of deskilling our staff.

The Board also acknowledged the strength of feeling heard during the engagement period but agreed that on balance the proposed changes were needed to offer the best experience and outcomes for patients and to address the challenges faced by health services.

The Board also agreed that there would be a formal evaluation of these changes over a six-month period, with updated recommendations presented to Board on 30 July 2025. This would consider patient safety, patient experience, and patient outcomes as well as feedback from patients, PTHB staff, primary care, social care and third-sector colleagues.

Implementation

Following the decisions of the Board on 10 October 2024, work took place to implement the temporary changes:

November 2024: Temporary changes to the opening hours of the Minor Injury Units in Brecon and Llandrindod Wells
December 2024: Temporary changes to inpatient wards including temporary establishment of the Ready to Go Home Units and Rehabilitation Units.

Six-Month Evaluation in July 2025

Following the implementation of these changes in December 2024, a six-month period of evaluation took place. The findings of this evaluation were presented to a meeting in public of the Board on 30 July 2025.

You can read the 30 July 2025 Board report here.

The July report considered a wide range of data relating to the safety and experience of services, as well as feedback from interviews conducted with people using services.

Findings from the evaluation indicated:

The change to MIU opening times had broadly positive effects, including improvements to service reliability, to staff and patient safety and to staff satisfaction. No significant increases in GP attendances have been identified; use of bank staff has reduced, and staffing costs have reduced 9%. There have been no unplanned closures to the service in the last six months. Staff utilisation has improved.
Similarly, broadly positive effects were been identified for Ready to Go Home Units and Rehabilitation Units. These include a sustained improvement in efficiency and flow, early signs of improved outcomes, reduced lengths of stay, more efficient deployment of staff and efficiencies in staffing costs.

Key findings from the interviews with residents staying in the units included:

Improved service reliability and patient outcomes
Positive feedback on the care received, the cleanliness of the wards and the catering
Positive feedback regarding the physiotherapy offered
A desire for more physiotherapy staff and sessions
Reduced travel time for many families and improved visiting flexibility
A lack of knowledge about the purpose of the Ready to Go Home units when a resident was transferred either from a district general hospital or another Powys hospital

A small selection of some of the feedback given by those in the units follows.

“I am amazed at how many patients have come through the unit and now gone home.” (Ready To Go Home Unit)

"I have been to exercises and bingo and quizzes. I enjoyed them. It makes it enjoyable having something to do. Over Christmas I went out for three nights with family.” (Ready To Go Home Unit)

“Going to the Gym has been the best, in the last few days I feel I have turned a corner, doing the horizontal bars. The second time I tried, I feel I can do it, it gives you a boost.” (Rehabilitation Unit)

Feedback was also received independently from visitors to the wards by the community connectors (PAVO) and representatives from Llais.

Based on this evaluation, the Board agreed that the temporary changes should remain in place for a further temporary period, with decisions due to be made through continuous engagement and future engagement on the health board’s Better Together Programme.

Keeping the Temporary Service Changes under review in Autumn 2025

The Health Board undertook a detailed review of the temporary service changes in July 2025. At that time, it was expected that formal consultation on Better Together proposals for adult physical and mental health community services would take place from Autumn 2025.

The Health Board has agreed that further work is needed on the Better Together programme, and formal consultation is now expected next year.

Any decisions on the future of individual wards (e.g. Brecon, Bronllys, Llanidloes or Newtown) or urgent care services (e.g. MIU opening times) need to be made as part of the “bigger picture” being developed through Better Together rather than as standalone proposals.

Planning is under way for formal consultation during 2026/27. Alongside this vital work we are keeping the temporary service changes under review.

We are seeking feedback from patients, staff, communities and stakeholders between November 2025 and February 2026. This includes keeping the quality and safety of these services under review, talking with patients using the services, talking with staff, and hearing from the public and wider stakeholders.

Your feedback will contribute to the next review of the Temporary Service Changes in March 2026.