Proposals to slash community hospital beds across some of Wales' most rural areas have met with the kind of fierce resistance you'd expect when you tell people in remote villages that their local hospital is now a 'hub' somewhere over the horizon. Powys Teaching Health Board wants to reduce inpatient beds from 146 to either 90 or 60, concentrating services in just two or three of the county's eight community hospitals.
Under the plans, inpatient wards could vanish entirely from Welshpool, Machynlleth, Ystradgynlais and Llanidloes, while Llandrindod Wells could also lose its beds under the most extensive option. The health board argues the current model is increasingly difficult to staff and deliver across such a sprawling geographical area, insisting the changes are needed to make services "safe and sustainable" - a phrase that has presumably been focus-grouped to within an inch of its life.
A 14-week public consultation on the future of health services in Powys is now under way, but GPs, politicians and communities have already lined up against the plans, concerned about the impact on an ageing rural population. In August, more than 400 people attended a public meeting in Llanidloes to oppose the closure of community hospital beds in the town, and a drop-in meeting was held there on Tuesday following a series of public meetings elsewhere in Powys.
Jill O'Connor, from the Llanidloes Hospital Alliance Group, said plans to deliver more care in the community were not workable, arguing it would be difficult to provide care for people living at least 20 or 30 miles out of town in remote rural areas - particularly in the middle of winter. "It beggars belief that they want to go and work, treat people in homes when actually... you can treat a bigger group collectively in a hospital rather than with individual staff," she said. "And we don't think that they've actually put the infrastructure in place. Yes, they will have excess numbers of nurses... from the hospitals that they're going to close, but those people need training up." She added: "The community feels very passionately that this is their hospital and it serves the community."
Powys has one of the oldest populations in Wales, with more than a quarter of residents aged over 65. The health board estimates the average journey time to inpatient care could rise from around 12 minutes to 24 minutes under the proposals - and for some people living furthest from hospitals, journeys could take more than 45 minutes each way. That's a long way to travel when you're already unwell, particularly in a county where the nearest general hospital might be in Shrewsbury or Aberystwyth.
Tuppin Scrase said his wife died five years ago after receiving palliative care in Llanidloes, and that he would not have been able to see her if she had been cared for further away. "At that time, it was the time of Covid, and if she'd had to remain in Shrewsbury or Aberystwyth, which are our nearest general hospitals, I could never have seen her," he said. "In the whole month it took her to die, I would not have been able to see her. It was only because it was local that I could actually get there and be with her."
Under its Better Together programme, the health board is proposing changes across a range of areas - adult physical health, adult mental health, urgent care and some diagnostic services. Among the proposals, the most controversial could affect inpatient beds in most of Powys' community hospitals, where occupancy rates usually run around 85 to 90%. Powys has no general hospital, but it does have beds in eight community hospitals. A report to the health board noted the current model "provides valued local services, but its dispersed configuration makes it increasingly difficult to meet needs consistently."
The first option would see beds located in three community hospitals in Brecon, Newtown and Llandrindod Wells, reducing the county's total from 146 to around 90 inpatient beds. The second option would see beds in just two community hospitals - Brecon and Newtown - cutting the total to around 60. Any changes would happen over a number of years, presumably giving everyone ample time to plan their journeys.
The health board also reports that about 40% of its budget is spent on services commissioned from outside Powys - around £198m in the last financial year. There are proposed changes to minor injuries units and urgent care too. Currently, 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 board believes the current service "does not provide consistent or equitable access across the county" and that demand for urgent care is increasing.
Two options are on the table for urgent care and diagnostics. The first would establish Urgent Care Centres (UCCs) in Newtown and Brecon, plus a minor injuries unit in Llandrindod Wells, all operating from 8am to 8pm, seven days a week. The minor injuries unit would stay in Welshpool until the UCC opens in Newtown - at which point the Welshpool unit would close. The second option would see just two UCCs, in Newtown and Brecon.
For mental health services, one option is proposed: consolidating 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, alongside expanding community mental health services.
The health board said its proposals respond to major challenges facing health services. "People are living longer, often with several long-term conditions; demand is rising; and recruiting and retaining the workforce needed to sustain small services across a large rural county is becoming increasingly difficult," Powys Teaching Health Board said in a statement. It said the overhaul was necessary to ensure services could "remain safe, effective and sustainable, while helping more people stay well, remain independent and receive care at home or closer to home" - which, for some, may be a home that's 45 minutes from the nearest bed.
The consultation closes on 10 January 2027.