Underfunding in Carmarthenshire and Pembrokeshire fuels hospital chaos, family hardship, and looming care home closures

VULNERABLE older people in West Wales are being forced to pay for their care—or go without it—due to a worsening funding crisis that experts say is placing them at risk and driving up NHS costs.

A growing “postcode lottery” in council funding has created stark inequalities between local authorities, with Carmarthenshire and Pembrokeshire among the worst hit. Care providers warn that the current situation is not only financially unsustainable but morally indefensible, as elderly people are left stranded in hospitals or charged extra just to receive basic care.

£8,500 less per patient

In Carmarthenshire, research has shown that the local authority pays around £8,500 less per year per person for nursing care than neighbouring Ceredigion. The shortfall is so severe that some care homes have begun charging families extra, or risk closure.

One care home owner, who asked not to be named, told The Herald: “It’s heartbreaking to tell a family: ‘If you can’t pay this, we’ll have to give notice.’ But we can’t make ends meet on Carmarthenshire’s fees. Meanwhile, just over the border in Ceredigion, they pay enough to cover the cost. Why are our residents treated like second class citizens?”

They added that some care homes avoid charging extra and are therefore more likely to receive referrals from the council—but may be located far from a resident’s home town, increasing isolation and hardship for families.

“The system punishes compassion. Homes are closing. And we’re losing places for our most vulnerable citizens.”

Pembrokeshire: NHS under pressure, families stretched

In Pembrokeshire, the situation is no better. While weekly rates are slightly higher than in Carmarthenshire—£908 for nursing care and £986 for EMI—they still fall far short of the actual cost of delivery.

The result? Bed-blocking at Withybush Hospital has reached critical levels.

Elderly patients medically fit for discharge are being kept in hospital, sometimes for weeks, due to a shortage of care home placements.

According to estimates, the cost of keeping an elderly patient in hospital is around £500 per day, compared to less than £200 per day in a care home—making the system not just inefficient but unsustainable.

‘12 months of instability’ ahead

One care group operating six homes in Pembrokeshire says they are facing a £150,000 annual hit due to increased National Insurance contributions and a rise in the Real Living Wage. They’ve warned of “12 months of instability”, with growing pressure on families to pay third-party top-up fees—and a risk that smaller care homes could fold altogether.

Care Forum Wales has estimated the total shortfall across the sector in Wales to be £150 million, describing the situation as an “existential threat” to elderly care.

Council and government response

Pembrokeshire County Council is already grappling with a projected £34.1 million funding gap for 2025–26, with adult social care listed as one of the most significant pressure points. Meanwhile, Carmarthenshire County Council has not issued a public statement on the care home funding disparity, despite repeated concerns from local providers.

The Welsh Government has announced a small uplift in care home fees, from £235.88 to £254.06 per week from April 2025, but providers say it’s nowhere near enough to prevent closures or redundancies.

Some initiatives—such as improved NHS discharge planning and tech-based bed tracking—are being piloted, but sector experts say they will not resolve the crisis without urgent and significant funding increases.

‘Rotten boroughs’ of care?

Mario Kreft MBE, chair of Care Forum Wales, has slammed the disparity between councils as a form of “institutional prejudice” against the private care sector, which provides the majority of services across Wales.

“It’s a race to the bottom, and elderly people are paying the price. In South West Wales, with the exception of Ceredigion, fee levels are appalling. These councils are like rotten boroughs, offering the least to the most vulnerable.”

“Wales was supposed to be built on equality. But you’d never know it when you look at how care is funded.”

He called on councils and government to rethink their approach, warning:

“Those making these decisions should consider their positions. They are causing harm to families and risking the collapse of care in their communities.”

What happens next?

If no action is taken, providers warn, more care homes will close, families will be left without support, and hospitals will continue to suffer.

“Either we fight to save our homes,” the anonymous care home owner told The Herald, “or we walk away. And then what becomes of the residents?”

The Herald has contacted Carmarthenshire and Pembrokeshire County Councils for comment. This article will be updated if and when responses are received.