There's a significant group of people in Pembrokeshire who often get missed in the official statistics and reports. They aren't in crisis right now, but they're always close to the edge. They don't fit neatly into the boxes of "healthy" or "unwell," "able" or "disabled," "independent" or "vulnerable." This is the forgotten middle—people who are only functioning because the alternative is just too scary to think about.
You might find people in this group working part-time out of necessity while managing chronic pain. Others are dealing with caring roles, anxiety, or past trauma, and have been officially assessed as "coping." Their daily lives are spent in the grey area between support thresholds, a place rarely acknowledged by the system, but one that really shapes our community.
The Problem with Getting Help
Right now, our support systems often mean you have to reach a point of severe breakdown before you qualify for help. Eligibility criteria, meant to prioritise those most in need, can actually stop people from getting help early on.
People commonly hear things like:
- "You don't meet our service criteria."
- "We can't take your case until your symptoms get worse."
- "Your disability level isn't high enough for this benefit."
- "You're managing your care needs too well for support."
While these decisions are often about logistics or lack of resources, the result is profound isolation. Every 'no' just reinforces the idea that you have to manage on your own.
In a county like Pembrokeshire, managing on your own means dealing with huge travel distances, unreliable public transport, and long waits for basic healthcare appointments. It means struggling to complete complicated online applications when the broadband is terrible. It's a constant effort to convince yourself that things are "not bad enough"—until, suddenly, they are.
A National Issue Made Worse Locally
Both Public Health Wales and Social Care Wales use the term “the missing middle.” This describes the large part of the population that is neither perfectly healthy nor in active crisis. They are in the space between proactive early help and reactive emergency care—a space that has ballooned over the last decade.
This missing middle includes people with mild to moderate mental health issues, long-term physical illnesses, learning differences, and complex issues like poverty or housing insecurity. They often juggle multiple stresses, but none of them, on their own, are serious enough to trigger a formal response.
In Pembrokeshire, these national issues are magnified by geography. Our beautiful coastline hides real access problems. Poor public transport, the digital divide, and a lack of face-to-face services mean small problems quickly become huge.
A ten-mile trip for a vital service can feel like a hundred when the last bus leaves in the early evening. Relying on national helplines is a nightmare when your mobile signal constantly drops out. Talk of 'digital inclusion' feels meaningless when the broadband often cuts out at home.
The Secret Cost of Constant Effort
Living in the forgotten middle demands constant endurance. People become experts at patience: waiting for return calls, waiting for appointments, waiting for validation. They manage their energy reserves as carefully as their money. They put off small necessities—getting medication, filling out forms, seeing friends—because every single action feels like a huge psychological effort.
To outsiders, this endurance looks like independence. To professionals, it's interpreted as stability. But underneath, it's a silent, slow drain. When people finally collapse, the system is often surprised, as if it was totally unexpected.
As one person in a Social Care Wales focus group perfectly summed it up:
“They said I looked fine—but that was just because I couldn’t afford to break down.”
That one sentence captures the whole reality.
Where The Real Support Comes From
In Pembrokeshire, help rarely comes from a single, giant service. It's a collection of small actions and consistent local effort.
It’s the neighbour keeping an eye on an elderly couple. The GP receptionist finding a cancellation slot. The local business owner noticing a regular hasn't been in for a while. The community worker driving extra miles to personally deliver necessary paperwork.
These are the 'micro-supports' that hold the community together—the unofficial safety net under the official framework.
Local charities like PATH Pembrokeshire, Citizens Advice, Mind Pembrokeshire, and PAVS play essential roles in filling the systemic gaps. They work with people who are too proud, too scared, or too tired to navigate the formal systems alone.
Independent community advocates—including groups like Dyfed Community Advocacy & Guidance—often step in here. They translate the official jargon (in English or Welsh), help people understand complex decisions, and ensure that those deemed "not unwell enough" aren't simply forgotten.
The Theory vs. Reality of Prevention
The Social Services and Well-being (Wales) Act 2014 set out a key commitment to early intervention and prevention. The vision was great—community working together, empowerment, and partnership. But prevention only works if you properly resource the people delivering it.
Over time, funding cuts and staffing shortages have forced a shift from proactive prevention to reactive crisis management. Instead of stopping problems when they start, services are now overwhelmed by having to respond only when things become critical.
So, prevention is a universally loved idea that few have the practical capacity to implement effectively. It requires investing in patience, time, and building trust—resources that are hard to justify in annual budgets or quarterly performance reports
The Human Impact of Eligibility Walls
For every person who gets formal support, a far larger number are sitting just below the qualifying line. They make up the huge caseloads for GPs, the long queues for mental health assessments, and the months-long waiting lists. They are often labelled "complex"—not because they are inherently difficult, but because no single agency fully owns their needs.
What this means in practice is people being bounced between services, forced to repeat their personal story until they are completely worn out. Eventually, some just stop asking for help. Silence becomes a way to survive.
This is where community advocacy is most vital: not to fight the system, but to keep the communication channel open. Its job is to make sure people are truly understood before they reach an irreversible breaking point
Real-Life Examples from Pembrokeshire
- A woman in Johnston, after surgery, is denied short-term social care because she can walk to the bathroom on her own—even though she can't safely prepare food or wash herself.
- A young man in Narberth with undiagnosed ADHD loses his job due to anxiety-related lateness, only to be told he’s not eligible for support because he's "not in crisis."
- An elderly farmer in Haverfordwest struggles with grief and alcohol but refuses to see a doctor, insisting he’s “coping”—until a neighbour finds him unconscious.
None of these are rare events. They happen all the time in a county that prides itself on being resilient. But resilience without support is just a polite word for barely surviving.
How We Can Close the Gap
What core changes are needed to shrink the forgotten middle?
First, we need to commit to a different way of listening. People don't always use clinical terms for illness or distress. They might say, “I’m just exhausted.” Or, “I’m managing.” There’s often a quiet plea for connection inside those statements.
Second, a much better structure for collaboration between official services and the community sector is crucial. Community Connectors, DDAS, PATH, Mind, Citizens Advice, and various advocacy projects all have vital pieces of the puzzle. Better integration would stop so many people from slipping through the cracks.
Finally, we must formally recognise and respect the quiet work—the unpaid, unseen labour of neighbours, informal carers, and volunteers who collectively sustain the social structure. They aren't a nice extra; they are the essential infrastructure of community compassion
Why Advocacy Still Matters
Advocacy isn't a cure-all or a replacement for statutory social work. But it does one fundamental thing: it translates the system.
It helps people understand what they’re entitled to, fill out forms correctly, attend key meetings, or chase up unanswered letters. It can turn confusion into a structured plan, and despair into a sequence of small, manageable steps.
At its best, community advocacy gives people the permission they need to ask for help—and to keep asking until their voice is heard. It ensures that those who are "not quite eligible" still have a voice in the places where decisions about their lives are being made.
The Reality of Being Isolated in the Countryside
For people outside Pembrokeshire, distance is often underestimated. In cities, support for the missing middle might be a short walk to a drop-in centre. Here, it often means a 30-mile round trip, or relying on risky, informal transport without guaranteed funding.
Digital services are great—but only if you have a computer, reliable internet, and the skills to use them. For many older or low-income residents, this is a total barrier. As DCAG highlighted previously in Disconnected: Life in the Digital Age in Rural Pembrokeshire, digital access is still very patchy and excludes many people.
When people struggle to access help, they internalise the message that the support wasn't meant for them.
Practical Steps We Can Take
Systemic change won't happen just by talking about it; it needs real shifts in how we think and how we take neighbourly responsibility.
- Proactively check in with people who seem to be "just managing."
- Share information—sometimes the whole intervention is just providing the right phone number or link.
- Support local community projects that do great work without making a big fuss.
- Acknowledge small victories; a successful outcome isn't always a full recovery.
Organisationally, Pembrokeshire already has good models to build on, including Community Wellbeing teams, Local Area Coordination, and strong third-sector collaboration via PAVS. But these only work if people on the ground genuinely feel they can reach them. That requires building trust—and trust starts with being visible.
The Conclusion
The forgotten middle aren't policy failures; they are symptoms of distance—geographic, bureaucratic, and emotional. They are the people holding their families together while personally wearing down. They are the ones who rationalise the silence from services that don't respond. They are the ones who, when finally prompted, say, “I’m fine,” because they’ve stopped expecting any other outcome.
Pembrokeshire’s core strength has always been its close-knit, resilient, and compassionate communities. If we want fewer crises, fewer emergency call-outs, and fewer local tragedies, we must stop waiting for people to hit rock bottom before we acknowledge their needs.
You shouldn't need eligibility criteria to receive compassion. A lack of clinical severity shouldn't mean you're treated without respect. Getting on a caseload isn't what determines your worth as a person.
If there is one key message DCAG wants to give to professionals, families, and residents, it is this: People should not have to fall apart to be seen.
References and Further Reading
-
Social Care Wales (2024). Preventative Approaches in Community Care: Learning from Local Delivery Models.
-
Public Health Wales (2023). Health Inequalities and the Missing Middle in Wales.
-
Pembrokeshire County Council (2024). Community Wellbeing and Independence: Local Area Coordination.
-
Dyfed Community Advocacy & Guidance (2025). Field Observations and Non-Statutory Community Case Examples.
-
Welsh Government (2014). Social Services and Well-being (Wales) Act 2014.
-
Welsh Government (2022). Programme for Government: A Stronger, Fairer, Greener Wales.
