Public feedback to inform Hywel Dda’s long-term strategy for healthcare delivery

NEARLY 2,000 people across Carmarthenshire, Ceredigion and Pembrokeshire have shared their views on what matters most for living a healthy life, as part of a major public engagement exercise by Hywel Dda University Health Board.

Over a nine-week period, residents were invited to respond to eleven key questions exploring how people stay well, how they access healthcare, and what improvements they would like to see in services, buildings and digital provision. The questions were shaped around feedback gathered from community members earlier in the summer.

The engagement focused on four main themes: a social model for health and wellbeing, digital healthcare support, balancing hospital care with community-based services, and priorities for clinical services and hospital redevelopment.

The feedback will be shared in January and used to inform a refreshed long-term strategy for the Health Board, setting out how safe, sustainable and accessible services will be delivered over the next fifteen years. While the strategy will be updated to reflect changes in clinical practice, technology and how people use health services, the Health Board says its overall ambitions remain unchanged from those set out in the original Healthier Mid and West Wales strategy in 2018.

Lee Davies, Executive Director of Strategy and Planning at Hywel Dda, said the process was about refinement rather than a change in direction.

He said: “Thank you to everyone who has taken the time to share their views. The direction of travel remains as per our 2018 strategy, so we want to reassure people that this is not a radical change of direction but rather a refinement in how we deliver the strategy. Your feedback is helping us reshape our strategy so that it continues to reflect the priorities of the people we serve, and the changes in clinical practice.”

During the engagement, many respondents highlighted the importance of strong communities, with families, friends and local support networks seen as key to helping people stay well and connected. Timely access to GP services was also raised as a priority, alongside concerns about travel to appointments, particularly in rural areas where public transport options can be limited.

Digital healthcare was another recurring theme, with people calling for online services to be simple, inclusive and accessible, while recognising that not everyone has access to technology or the same digital skills.

At its public Board meeting in November, Hywel Dda University Health Board considered progress on refreshing the strategy and received updates on the development of a new Primary and Community Care Strategic Plan. That plan, which has been shaped through further public engagement including in-person and online events and an online questionnaire, is due to be presented to the Board in January 2026.

The Primary and Community Care plan will set the overall direction for services delivered outside hospital settings and support locally-led plans for how care is provided in individual communities.

The Board also discussed a request from the Welsh Government for an addendum to the Health Board’s 2022 Programme Business Case. This will explore additional options for improving healthcare estates, including whether new facilities could help address existing infrastructure problems. It will also consider how local plans align with the national strategy, A Healthier Wales, which aims to shift more care into community settings and closer to people’s homes.

A draft version of the refreshed strategy is expected to be presented to the Board in January 2026 for approval. Once agreed, it will be published in accessible formats, with the Health Board saying communities will continue to be involved as plans move forward.

Further information about the engagement process and updates on the strategy are available through the Health Board’s public consultation platform.

RESIDENT doctors across Wales have voted to accept a new contract, with 83% of those who took part in a referendum backing the agreement, according to BMA Cymru Wales.

The contract includes a four per cent additional investment in the resident doctor workforce and introduces a range of reforms aimed at improving training conditions, wellbeing and long-term workforce sustainability within NHS Wales. The BMA says the deal also supports progress towards pay restoration, which remains a central issue for doctors.

Key changes include new safeguards to limit the most fatiguing working patterns, measures intended to address medical unemployment and career progression concerns, and reforms to study budgets and study leave to improve access to training opportunities.

Negotiations between the BMA’s Welsh Resident Doctors Committee, NHS Wales Employers and the Welsh Government concluded earlier this year. Following a consultation period, a referendum of resident doctors and final-year medical students in Wales was held, resulting in a clear majority in favour of the proposals.

Welsh Resident Doctors Committee chair Dr Oba Babs Osibodu said the agreement marked a significant step forward for doctors working in Wales.

He said: “We’re proud to have negotiated this contract, which offers our colleagues and the future generation of doctors safer terms of service, fairer pay, and better prospects so that they can grow and develop their careers in Wales.

“This contract will help to retain the doctors already in training, and also attract more doctors to work in Wales, where they can offer their expertise and benefit patients.”

Dr Osibodu added that the BMA remains committed to achieving full pay restoration and acknowledged that challenges remain for some doctors.

“Whilst this contract sets the foundations for a brighter future for resident doctors in Wales, we recognise that there are still doctors who are struggling to develop their careers and secure permanent work,” he said. “We need to work with the Welsh Government and NHS employers to address training bottlenecks and underemployment.”

The Welsh Government has previously said it recognises the pressures facing resident doctors and the importance of improving recruitment and retention across NHS Wales, while also highlighting the need to balance pay agreements with wider NHS funding pressures and patient demand.

The new contract is expected to be phased in from August 2026. It will initially apply to doctors in foundation programmes, those in specialty training with unbanded rotas, and new starters, before being rolled out to all resident doctors across Wales.

NHS WALES has spent more than £15.5 million on agency radiography staff over the past five years, as mounting pressure on diagnostic imaging services raises concerns about long-term workforce sustainability.

Figures obtained by the Welsh Liberal Democrats through Freedom of Information requests show that spending on temporary radiographers almost doubled between 2020/21 and 2023/24, despite relatively low headline vacancy rates across Welsh health boards.

Radiographers carry out X-rays, CT, MRI and ultrasound scans, which are essential to emergency care, cancer diagnosis, trauma treatment and elective surgery. Delays or shortages in imaging services can have a knock-on effect across patient pathways, slowing diagnosis and treatment.

The data also highlights an ageing workforce. More than a quarter of radiographers in Wales are aged over 50, with more than one in ten aged 55 or above. In some health boards, a significantly higher proportion of staff are approaching retirement age, raising concerns that experienced radiographers could leave faster than they can be replaced.

Betsi Cadwaladr University Health Board recorded the highest agency spend, at more than £8.1m over the period covered by the FOI requests. Other health boards also reported growing reliance on temporary staff to maintain services, particularly where specialist skills are required.

While official vacancy figures remain comparatively low, professional bodies have previously warned that vacancy data does not always reflect pressure on services, as posts can be held open or covered through overtime and agency staff rather than filled permanently.

Diagnostic imaging demand has increased steadily in recent years, driven by an ageing population, advances in medical imaging technology, and rising referrals linked to cancer and long-term conditions.

Commenting on the findings, Welsh Liberal Democrat Leader Jane Dodds MS said:

“Radiographers are absolutely vital to the NHS. From diagnosing cancer to treating people in A&E, the vast majority of patient journeys depend on timely access to scans.

“These figures show a system increasingly relying on expensive agency staff while failing to plan properly for the future workforce. That is not fair on patients, and it is not fair on staff who are already under huge pressure.

“The Welsh Labour Government must take urgent action to improve recruitment and retention, support experienced staff to stay in the workforce for longer, and ensure NHS Wales has a sustainable radiography workforce fit for the future.”

The Welsh Government has previously said it is working with health boards to improve recruitment and retention across NHS Wales, including expanding training places and supporting flexible working arrangements to help retain experienced staff. Ministers have also pointed to record numbers of staff working in the NHS overall, while acknowledging ongoing challenges in hard-to-recruit specialties.

However, opposition parties and professional bodies continue to warn that without long-term workforce planning, reliance on agency staff could increase further, adding to costs and pressure on already stretched diagnostic services.