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Mark Drakeford, Minister for Health and Social Services

First published:
24 January 2014
Last updated:

Following representations from local Members, clinicians  and community representatives I have decided to commission the Welsh Institute for Health and Social Care (WIHSC) to carry out an independent study of the issues and opportunities for providing accessible, high quality, safe and sustainable health services, which are best suited to the specific needs of people living in Mid Wales.

The outline terms of reference detailed below include consideration of patient outcomes and experiences and  working with clinicians and other professionals and their representative bodies, service providers from the health sector and other key agencies and people living in Mid Wales to explore:  how service delivery models across primary and community care and the secondary care provided at Bronglais Hospital can be best developed; opportunities to deliver more care at or close to home, such as through the use of telemedicine and telehealth; and workforce roles and models (including opportunities for partnership arrangements with specialists and the development of more 'generalist' roles).   The study will draw on the work of the Rural Health Implementation Group, which was set up to support the implementation of the Rural Health Plan, as well as international models of practice. 

This study will help to inform Local Health Board service plans.  When complete, I will expect Hywel Dda, Powys and Betsi Cadwaladr Health Boards, which are responsible for meeting the health needs of people living in Mid Wales, to respond to its findings through the refresh of Medium Term Plans undertaken by all Health Boards in the Autumn.   The NHS Wales Planning Framework, recently issued, made explicit the requirement for these plans to respond to the needs of local populations and reinforces the specific requirement to take account of delivering health care services to rural communities.
I have asked WIHSC to take soundings from a range of key stakeholders in order to  conclude final details of the proposed study over the next 3 – 4 weeks.



Mid Wales Healthcare Study
Aim and Objectives

To identify the issues and potential solutions (including models) for providing accessible, high quality, safe, and sustainable healthcare services, which are best suited to meet the specific needs of those living in Mid Wales.  The study should set out what could be done now and in the future, specifically considering:

  • health needs and public expectation – including: preferences for care to be delivered close to home; tackling health inequalities; Welsh language service provision; and evidence of the effect of wider determinants of health (e.g. physical and social isolation, access to transport, lower than average earnings) observed in the population of Mid Wales;
  • workforce models – including profile, recruitment and retention, professional standards, service implications (quality and configuration) and future models (e.g. plans for developing the rural practitioner role, generalists, buddying arrangements with tertiary centres, outreach clinics etc.);  
  • service organisation models, funding, and sustainability – including plans and perspectives on the configuration best suited for delivering  the best health outcomes for patients in Mid Wales;
  • innovation and application of new models – including, the extent to which there are firm proposals, or wider opportunities, for the utilisation of health technologies and telemedicine, telehealth, Skype, phone, e mail and other digital technology to improve accessibility and service quality;
  • service integration – opportunities for strengthening partnership working, particularly the health and social care interface and voluntary sector providers; and
  • any issues presenting along the England and Wales border.



Two stages are envisaged.  The first, lasting around 3 - 4 weeks, will involve initial discussions with key stakeholders to explore the issues, develop an appropriate methodology, and timetable for the study.  Whilst the second stage will be subject to the discussions undertaken in the first, a primarily qualitative method is envisaged:

  • distilling the current evidence on the specific pressures facing service delivery in Mid Wales, including published literature, the Rural Health Plan (including underpinning studies), and the work of the Rural Health Plan Implementation Group;
  • a review of the published literature on models of service delivery that are resulting in improved outcomes for people living in sparsely populated and predominantly rural areas;
  • analysing the Medium Term Plans in development (including the available underpinning research/analysis), with a focus on their consideration of the specific and cross cutting issues facing service delivery in Mid Wales.  This should include a consideration of recent developments underway in each Health Board;
  • interviews/workshops with lead managers, health and social care professionals, professional and representative bodies (including Royal Colleges and Deanery) third and independent sectors  that all have an interest in taking action to improve the health and wellbeing of people living in Mid Wales.  This should not be constrained to those working for NHS Wales; and
  • interviews/workshops with local community members and groups, to understand their concerns and improvement priorities.


Timetable of Events

The contract will start immediately, with a more detailed methodology and timetable being delivered in 3 - 4 weeks.


The output from the first stage will be a clear methodology and timetable.  The output from the second stage will be a concise report addressing the requirements set out above and any subsequent requirements emerging through the exploratory stage of the research.  The report will clearly articulate views on what should be done to better meet the health needs of those living in Mid Wales. This will include clear advice on future sustainable models of service and will include a consideration of Bronglais Hospital.