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.