Tuesday, 10 July 2012

Dodgy Dossiers & The Case for Change

Oh, God! Here we go again!
(Pic : Kitchagogo)

The "Dodgy Dossier"

As you probably already know, a major row has erupted over e-mails between the author of reports into NHS reorganisation in Wales - entitled under the umbrella The National Case for Change - and senior Welsh Government officials.

ITV Wales, The Western Mail and Betsan Powys give glimpses into what was written. The full e-mails are available here.

A Welsh civil servant is reported as suggesting that the report needs to:
"....be more positive if possible i.e describing a persuasive vision of how things could be better."

While the author of the report asks for:
"killer facts....the evidence as presented does not seem to be as incisive as we might have hoped."

There were further suggestions that desirable new services, and ways of delivering them, could be included.

So, were the Welsh Government actually writing this "independent" report - used as justification for the Welsh Government's own NHS reforms? Or was the "independent expert"?

None of this means that the report itself was biased/a PR exercise, but its validity has now been thrown into doubt. Darren Millar AM (Con, Clwyd West) has gone so far as to call for Health Minister Lesley Griffiths' (Lab, Wrexham) resignation if she had knowledge of the e-mails.

Smooth move – not. Nobody was calling for Edwina Hart's resignation over the Green Investment Bank bid, which was probably a far more serious blunder than this.

Elin Jones AM (Plaid, Ceredigion) took a slightly more measured approach by saying that, "a conclusion was decided on up front and that the correspondence illustrates a desperate search for the evidence to back it up." Kirsty Williams AM (Lib Dem, Brecon & Radnor) has said (quoted via Valleys Mam) that this, "clearly contradicts the Health Minister's statements that the case for change report was an independent assessment."

There have also been calls for a no-confidence vote - as reported in the Evening Post - coming from Mid & West Wales AMs, whose patch is on the front lines of Labour's NHS reorganisation.

I don't think that will happen either. It would really put Keith Davies AM (Lab, Llanelli) in a bind. He's going to wish Helen Mary Jones had knocked on a few dozen more doors when this kicks into top gear.

Lesley Griffiths herself issued a pretty strong rebuttal to the accusations in an urgent Q&A session earlier today, and maintains that the report's contents were "independent" and based upon "clinical evidence". That's the party line sorted, but she's probably right too.

The Case for Change

AWEMA was strike one. The Green Investment Bank was strike two. I said back in March that the "third dropped bollock" was forthcoming. This, ladies and gentlemen, is strike three.

Carwyn Jones has to do something to restore credibility to his government, but calls for resignations and votes of no-confidence are premature. Ministerial "scalps" should only be used for gross incompetence and corruption. That isn't evident today, but this is yet another big bungle for the Welsh Government.

The response probably means revisiting the NHS reorganisation, making significant changes, but patience and time are in short supply.

If Lesley Griffiths told the civil servant, in person, to offer "tips" to the report author, then her position will be untenable. Try proving that. Accuse me of being naive all you want, but I doubt that's the case. I'd hate to think our ministers would be that dim. Heh.

Lesley Griffiths hasn't really done anything wrong. There's no evidence (so far) that indicates she knew about the e-mails - even if she couldn't avoid them in her capacity as Health Minister. It's her word against Darren's.

Like the Green Investment Bank Bid, I'm going to have to return to the civil service issue again.

Can any of the people reading this, who don't work in the NHS, name the chief executive of their Local Health Board without looking it up? Who actually governs Wales? Who are the people actually making these decisions?

Lesley Griffiths is a patsy. Any NHS changes in Wales are going to have her face and name next to them – especially those changes which are "too radical and wide ranging" for the electorate. That's not entirely fair on her, or us.

This is a major problem. We should expect our ministers to be able to make decisions autonomously. All the civil service has to do is provide impartial advice. They shouldn't have been able to offer "tips" to someone writing an "independent" report without fear of being found out and sacked.
What's becoming clear, is that the relationship is the other way around. "Officers" make the decisions, Welsh Government ministers rubber stamp them, AMs debate those rubber stamps.

Wales is currently being run like a county council, not a nation.

On the NHS reforms themselves - we don't like being lied to.

That's what we've had for some time now. Lie, after lie, after lie. We've had obfuscation on "downgrading", cover ups on health board bailouts and we still haven't had the plans properly debated yet - only a glorified ministerial statement.

Now we have an "independent" report, that might've been leaned on by civil servants, possibly with the Health Minister's knowledge. That's another potential lie, and a pretty serious one. If it were true, it would mean Lesley might have "misled the Assembly". That's something you shouldn't be able get away with.

The NHS – which should've been Welsh Labour's strong point considering what's happening in England - is now becoming their Achilles heel.

Labour can accuse opposition parties of "destabilising key NHS reforms" all they want, but they're doing a pretty good job of that themselves. I say that as someone who supports the creation of "centres of excellence". If they've had that effect on me, I can't imagine what effect they've had on those who oppose it.

The opposition parties, meanwhile, are either going to have to offer an alternative, or try to influence decisions, because changes are absolutely vital.

With improvements in emergency care, in many cases, it's no longer critical to have full-time A&E departments in every major population centre.

With more expensive treatments, keeping people in hospital is becoming more costly. Wales can't continue to rely on our bigger hospitals to deliver basic/routine services, or act as a hotel for the elderly.

With more innovative treatments, not every single hospital in Wales will be able to offer them – they will need to be centralised near areas with good medical research and teaching facilities. In most cases that means Cardiff, Swansea or the big north Wales hospitals.

I think the only option now, is to rip up Case for Change and present a brand new one, in full consultation with the public and ideally with cross-party support. That might be a delay the Welsh Government can't afford, but they've lead to this situation through their own bungling.

Local Health Boards and the Welsh Government are also going to have to treat the public with a bit more respect. I don't think we'll stand for changes forced through because Labour, or civil servants, have decided that's what's best for us. Present your case, be honest and present all the alternatives.

We need a rational debate on the future of the NHS, even if the Assembly doesn't seem able to provide that at the moment.

The romanticised NHS of Nye Bevan is dead. Wales has to let go of it. I don't envy Welsh Labour's task in doing that, but that's no excuse for making such a ham-fist of it.


  1. Absolutely spot on. Centralisation of NHS services is largely unavoidable, and will actually improve patient care, but the way it's being introduced is cack-handed and devious.

  2. well said, this was an accident waiting to happen mainly due to Welsh Labour putting so little effort into making the case and selling the changes to a skeptical public of the real need for reform in certain area of the NHS for a number of years.

    But i'm not convinced about a new report, would any report on Welsh NHS reorganisation be entirely free of political interference given the sensitivities involved and lets be honest who would want to author it after this sorry episode.

  3. Again we have a democratic deficit, unelected appointed health boards make decisions, which ultimately are political, acting on the direction of the minister in theory, but from chief executives of the authorities in practice. My solution is to recognise the political nature of the decisions about configuration and create regional authorities in Wales to take over the control of the boards and quangos that run much of our lives. I have suggested 5 regional bodies, elected by STV, using the local authorities as multi member constituencies. Each between 30 and 45 members, running health and social services, the police, fire and civil emergencies, also I'd add education and waste disposal. This would align the multiplicity of boards with different boundaries to a common regional set up. Democratise the lot, devolve from the centre to these new regions and lets be honest about decisions being political.

    I have set this out in a post

  4. Let's be honest here.

    Professor Marcus Longley has shown himself, deliberately or not, to be an instrument of the Labour Government's plans for the NHS in Wales.

    Perhaps the worse thing that has happened to him is that Labour ministers, including the FM, have use him as a shield for Leslie Griffiths and officials.

    That is the shameful behaviour today - that the leader of this nation hides behind an academic rather than coming out and defending his own policies.

  5. anon 22.57 comment is from is a well known Lib Dem AM blogger, he can't be finding much support for his parties all out attack on the Health Minster or Marcus Longley.

  6. Thanks for the comments everybody.

    I think you've both (Lyndon and ACOP) summed up my own views well. I'll have more on this in the build up to the "vote of no confidence" next week.

    Cibwr - I agree near enough entirely. I was going to do a five-parter on local government and independence this summer, but I've pushed it back to next year. Some of my own ideas are very similar to your own, and I will be citing you if/when I come around to doing it.

    Anon 22:57 & Anon 23:13 - I'd be disturbed if party political campaigning in Wales has been reduced to anonymous comments on blogs like this one, but I have no proof otherwise.

    Anon 22:57 does have a point, though I think Lesley Griffiths is as much a "victim" in this as Prof. Longley. The clinical directors and civil servants are the puppet masters in all this. I'm annoyed that they are both (LG and Prof. Longley) being used as human shields to deflect criticism. It's not as if the changes aren't going to come eventually. Again I'll have more on this next week.

  7. The report was supposed to also include a view on the CHC's appointed by Edwina Hart in 2010.
    I am a former member of the said CHC's and along with many others left/were pushed because we DID ask questions, and were not allowed to ask questions or raise concerns - unless they were passed to the Chief Officer and upward to the Ministerial realm.
    Swansea (ABM) CHC had a Labour councillor appointed as Chief Officer !
    If you want to save money then get rid of these 'civil servants' appointed ultimately by the Health Minister. The salaries paid to these nepotismally appointed people is brethtaking - as well as the 'course' they book themselves on, the 'mileage' they claim and the claims for subsistance ( food taken during the day if they are at meetings - they attend as many as possible!).
    It costs Millions of £s to keep the CHC offices open -the members are ministerial appointees, council appointed and appointees from the voluntary sector - all these are volunteers- they can claim mileage etc. but many I know from Swansea CHC did not claim or donated it to good causes.
    The Welsh government seems to look after its own. I along with several members/ former members were to be contacted by Marcus Longley and were not - I believe this was on instructions of Lesley Griffiths. The whole of this report and the integrity of Lesley Griffiths has been called into question - she should go and the report sent to the archives. What is about to happen in the health provision in Wales will be controversial - it may have to be done , but lets have honesty and integrity in our government.

  8. I'm not shocked by anything you've said, Anon. I've come to expect things like that now. It's become part of the political process. I don't think that's necessarily a Labour problem.

    If we can have elected police commissioners, then why not health commissioners, fire commissioners, waste management commissioners etc? We shouldn't be putting people in these jobs that can't be touched if they screw up, or remain anonymous.

    Maybe our politicians won't have such a cosy relationship with them, or be able to put too much pressure on them, if they were appointed by the electorate.