Community by Design needs a workforce by design

Community by Design offers Wales an important opportunity to rethink how healthcare is delivered. Its central ambition is one that we support: to improve access, prevent ill health and provide more joined-up care closer to people’s homes. Care should be planned around the needs of patients, rather than the boundaries between different organisations or parts of the health service.

At the 2026 Plaid Cymru annual conference earlier this month, we brought clinicians and politicians together to examine how that ambition can be delivered. The discussion included Welsh government cabinet minister for health and care Mabon ap Gwynfor MS, deputy minister for public and preventative health, Nerys Evans MS and acute medicine and respiratory consultant, Dr Sarah Dyer.

• Read Workforce planning will be key to delivering Community by Design, says RCP Cymru Wales

We must address today’s pressures

Any discussion about the future of healthcare must begin with the pressures facing patients and clinical teams today.

At our conference session, Sarah brought the realities of acute medicine into sharp focus. Reflecting on the impact of corridor care on patients and staff, she reminded us that we cannot focus solely on designing tomorrow's health service while overlooking the people who need hospital care today.

Sarah's comments highlight a wider challenge. Community and hospital care are sometimes presented as competing priorities, but patients move between services throughout their care. Pressure in one part of the system is quickly felt elsewhere. Better prevention and earlier support should reduce some demand for hospital care, but many patients will continue to need specialist and acute services. Community services and hospital care must therefore develop together.

Community by Design needs a workforce by design

Providing specialist care closer to home can make a real difference for patients, reducing unnecessary travel and making care easier to access. But delivering care in the community does not remove the need for specialist expertise, time or capacity. During our conference discussion, we explored examples of services that improved patients' experiences while highlighting the practical challenges of providing care across large geographical areas and maintaining hospital services.

This is why Community by Design must be accompanied by a workforce by design. If clinicians are expected to provide specialist advice earlier, support prevention and work across community and hospital settings, that work must be planned and resourced properly.

New models of care require more than good intentions. They require the right people, enough time and services that work together across the whole patient journey. Community by Design cannot simply be about moving services out of hospitals. It must be about designing a health service that works better for patients wherever they receive care.

Why community and hospital care cannot be planned separately

Hospitals will remain a vital part of healthcare in Wales. Patients with complex or deteriorating conditions will continue to need specialist expertise, diagnostics and treatment. That is why hospital and community care cannot be planned separately. Community services can help people receive care earlier and closer to home, while hospitals provide specialist care for those who need it most.

Clinicians must be involved from the outset

Physicians see every day how organisational boundaries affect patient care. Our members see where communication breaks down, where patients can fall between services and where delays create unnecessary risk. That experience should help shape new services from the outset. Involving clinicians early will help ensure new models of care are practical, safe and effective.

The same principle applies to technology. Clinicians need access to the information required to make safe decisions and provide joined-up care. Technology alone will not transform healthcare, but better digital systems can improve communication, reduce duplication and create a better patient experience.

Turning ambition into better care

Community by Design gives Wales an opportunity to build a more preventative, integrated and patient-centred health service. We should embrace that opportunity, but we must also be realistic about what it will take to deliver it. Providing more care closer to home will require investment in the workforce, services and technology that support patients across the whole health system.

Above all, change must be shaped by the people who deliver and receive care. Patients do not think in terms of organisational boundaries. They want care that is joined up, timely and available when they need it. If we get the balance right between community care, hospital services and workforce planning, Community by Design can deliver better care and outcomes for patients across Wales.