'Uncharted Waters' in Powys.

Powys County Councillors are embarking on an uncertain journey which will have huge impact on the delivery of public services in Powys. Today, there was a meeting of the Council's Executive Board, which discussed a proposal that there should be a merger of the Powys County Council and the Powys Local Health Board. The proposal put forward by a joint project team reads 'a merger to form a single organisation should be pursued, with a target date of April 2012'. Wow - this is big stuff. Its never been done before - anywhere. And its moving forward with quite stunning speed. This is a first stab at giving this outsider's view on what it all means.

Its being sold as a merger of equals - but it looks to me like a takeover by the Council. Under discussion is the placement of healthcare delivery in Powys under the control of local councillors for the first time since the NHS was established in the 1940s. 'Innovative' seems an inadequate word to describe what's being proposed. Its impossible for anyone outwith the discussions that have been taking place to judge whether this is a good idea or not. Instinctively, I feel supportive, but would need a lot of assurances about money from the Assembly Government. The Local Health Board has been running a massive annual budget deficit, and I'd want to know what's going to happen to it.

Biggest concern for me is the future of our local hospitals. For years, I've heard noises coming from the Local Health Board that our hospitals are financially and clinically unviable. We know that a report has already has informed us that they are not clinically safe - which is a shocking state of affairs. Today, an 'insider' tells me that all but two or three Powys hospitals could be closed. It's not a reason to reject the merger, but Councillors need to enter the new arrangements with their eyes wide open about the difficult decisions that lie ahead.

In general, I'm deeply concerned about our local services. I've long predicted that Powys County Council is intent on closing dozens of our small primary schools, and now I can see most of our local hospitals closing as well. And this is as much a recognition of reality as disagreement with policy. Rural services are under threat as never before. Anyone who cares about rural services must be deeply worried about the uncertainties and challenges that face those of us who depend on them today.