The commissioning of treatment for Powys patients will have to be reviewed for the new financial year, the health board chief has warned.

While plans to delay cross-border treatment for Powys patients this financial year may have been scrapped, chief executive Hayley Thomas said the health board is in its ‘most challenging position’, ‘facing a serious financial situation’.

Health Board members supported a recommendation not to implement any changes to elective activity in quarter 4 of 2024/2025

But they also unanimously agreed that further work is required with NHS England providers to review the approach to commissioning activity in 2025/26 within available resources.

Powys Teaching Health Board Chief Executive Hayley Thomas told a meeting last week; “We will need to review our approach to commissioning in the future to provide sustainable services in the next financial year.

“We also need to think about changing future demand, shifting towards prevention and that will be discussed in the March health board meeting.

“We are in early discussions with the Welsh Government to discuss the commissioning of treatment in the future and I will have to write to Welsh Government to explain the current situation, the discussions which have taken place and we will need to revise our financial focus for the year end.”

Ms Thomas said she will ask the Welsh Government for additional strategic cash support to cover the end of the financial year.

Ms Thomas said they need to further strengthen primary care and do more work within Powys, which they have done in previous years. She said with regard to future commissioning with NHS providers, they would look at the best, worst and most likely scenarios when they put together the budget for 2025/26 and learn lessons from this year’s challenging situation.

But she said they want to avoid disputes with their NHS England providers so they want upfront discussions for the next financial year to give them more certainty too.

Katie Blackburn, chief officer for Llais, the public’s voice on health and social care matters, said: “We will continue to share what Llais has heard from the communities to help inform the health board’s discussions and decisions.” She re-enforced the need for continuous engagement and communication.

Ms Thomas said the health board had talked with Oswestry, Shrewsbury, Telford and Hereford hospitals, and the integrated care scheme within Powys in recent weeks.

They tested two scenarios – scenario one - deferring operations for those patients who are not yet booked in and scenario two deferring operations for those already booked in.

Ms Thomas said patients could have been delayed by three to nine weeks and scenario one would have saved about £924,000 while scenario two would have saved just over £2 million.

She said there could have been significant administrative issues such as contacting and re-booking patients but although deferring elective activity would have increased waiting times for a significant number of patients, the majority would still have been seen in line with Welsh Government waiting targets.

She said there were a number of risks and significant impacts and delivery confidence remained low and that was why she recommended scrapping the idea for quarter 4 of 2024/25.