From 1 April 2026, Local Health Boards will run direct payments for healthcare in Wales as ministers move to implement the Health and Social Care (Wales) Act 2025. For North Wales families who routinely head to Chester or Liverpool for appointments, the shift is meant to shape support around everyday life, not just service pathways. (gov.wales)

Direct payments will start with people eligible for Continuing NHS Healthcare (CHC). Instead of the board arranging every element, an individual can request a budget to buy the support they need. It won’t be automatic: access depends on eligibility and regulations due to be finalised early this year. (legislation.gov.uk)

The legal mechanism is straightforward. Welsh Government plans to amend the 2009 Directed Functions rules so health boards exercise Welsh Ministers’ new powers under sections 10B and 10D of the NHS (Wales) Act 2006-meaning boards can make and manage direct payments and arrange help from other bodies to support people using them. (gov.wales)

Why it matters on our side of Offa’s Dyke: cross‑border care is routine. In 2024–25 there were about 64,300 admissions of Welsh residents to English NHS hospitals, and just over 30,000 Welsh residents were on English waiting lists as of March 2025. Changes in how care is funded and arranged will ripple along the A55 and M56 corridors. (gov.wales)

That includes the Countess of Chester, which serves the Deeside area of Flintshire and works closely with Betsi Cadwaladr University Health Board. For families shuttling between Wrexham, Deeside and Chester, direct payments are billed as a way to give more choice and control over care. (coch.nhs.uk)

In Powys, where so much hospital care is commissioned in England, the pressures have been stark. In 2025 the health board signalled slower elective referrals to English hospitals to balance its budget, a move implemented from 1 July after earlier plans were paused-prompting local protests. Direct payments won’t fix waiting times, but they may give some residents more say over day‑to‑day support. (shropshirestar.com)

Right now, if someone moves from local‑authority direct payments into CHC, health boards cannot provide a direct payment and families worry about losing familiar carers. Welsh guidance already stresses ‘voice and control’ in CHC; the new scheme is designed to put money and responsibility with the individual, with safeguards and support around it. (gov.wales)

Boards now face the operational slog: recruiting specialist staff, building finance checks, lining up payroll and support services, and training assessors. Ministers say preparatory funding of £150,000 has been released this year, with guidance and a rapid evidence review informing local plans ahead of April. (gov.wales)

The powers sit in the 2025 Act, which inserted sections 10B–10D into the NHS (Wales) Act 2006 to allow payments, set conditions and bring in other bodies to help, including where someone lacks capacity. Detailed rules will be set out in the National Health Service (Direct Payments) (Wales) Regulations to be laid in early 2026. (legislation.gov.uk)

The timetable is tight. Consultation on the draft regulations closed on 8 October 2025; ministers plan to publish a summary and lay the final regulations for Senedd scrutiny in early 2026, with a 1 April start. Households across North Wales-particularly those using hospitals in Chester, Liverpool and Manchester-should speak early to CHC leads about whether a direct payment could fit their care plan. (gov.wales)

The policy is being taken forward by Dawn Bowden, the Minister for Children and Social Care. Her portfolio covers social care reform alongside this health measure, and she signed recent updates confirming the April 2026 go‑live. (gov.wales)