Critical NHS report by National Clinical Forum rewritten

Ysbyty Glan Clwyd Glan Clwyd hospital's neonatal services could be moved to Wirral under the plans

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Conservatives have demanded to know why an independent report criticising NHS changes in north Wales was rewritten after being submitted.

The National Clinical Forum (NCF) warned the Betsi Cadwaladr University Health Board (BCUHB) changes were "unsustainable" in the long term.

But this was retracted after Mary Burrows, head of BCUHB, intervened.

She said the NCF was asked to "clarify" specific proposals in the document.

Tory health spokesman Darren Millar said redrafting the report undermined the credibility of the NCF as well as the wider process of reconfiguring health services in Wales.

Start Quote

Darren Millar

It's not appropriate for an independent chair of an independent forum to completely rewrite a report and then submit it as though it's the forum's report”

End Quote Darren Millar AM Conservative, health

He told Radio Wales: "What clearly has happened is that there have been private discussions between the chief executive of a health board and the chair of the National Clinical Forum.

"And, as a result of those private discussions, the original submission which was heavily critical of the health board's proposals, has been significantly changed and a new submission has been made which fully supports the proposals.

"That cannot be acceptable - if there were points of clarification required, then they should have been requested by the health board through formal and normal procedures.

"It's not appropriate for an independent chair of an independent forum to completely rewrite a report and then submit it as though it's the forum's report, without proper consultation with other forum members."

Mr Millar added that it was "disappointing" that senior Welsh government officials knew that the submission had been made and withdrawn but did not step in.

The NCF was set up in 2011 by Health Minister Lesley Griffiths to act as an independent and wide ranging body made up of clinical experts who provided assurance that health changes were clinically safe and met needs.

Analysis

We've obtained a copy of the original report which shows the significant changes that were made.

The original says that in some areas advice from bodies such as royal colleges had not been heeded. It is concerned about a lack of timescales.

It also worries plans to continue core services in three hospital sites could prove to be unsustainable given recruitment and training pressures in specialities like A+E and paediatrics.

The redrafted version makes it far more explicit that the panel supports some of BCUHB's specific proposals - which include closing some community hospitals.

The original submission says BCUHB's consultation proposals "whilst having merit in some aspects of change are in the forum's opinion unsustainable in the long term and require significant reconsideration".

The redrafted version says the NCF "supports the proposals and the changes which in its opinion will aid the development of a high quality sustainable service for north Wales".

Now it has also come to light the NCF also redrafted its assessment of plans by Hywel Dda health board to change services in mid and west Wales.

Under BCUHB proposals being tabled, a number of minor injuries units could be closed along with community hospitals, while neonatal intensive care at Denbighshire's Glan Clwyd hospital and others would be moved to Arrowe Park in Wirral.

NCF chairman professor Mike Harmer said the report needed rewriting "to ensure there was no ambiguity" and claimed the underlying message of the revised submission was the same as the original.

The heavily revised final draft removed references to an "impending crisis" in staffing and "unrealistic and unsustainable" hospital configuration and lack of timescales.

Mr Harmer is a former deputy chief medical officer of the Welsh government and chairman of the Welsh Health Specialist Services Committee.

The NCF has also agreed to revise its submission on a second set of reconfiguration plans by the Hywel Dda Health Board.

Mr Harmer said: "On receipt of the forum's response, Mary Burrows, the chief executive of Betsi Cadwaladr University Health Board, asked me to clarify the forum's exact stance in relation to a number of the specific questions contained in the health board's consultation document.

"The initial response, as it stood, was felt to be ambiguous on some issues.

"I felt it was important to ensure there was no ambiguity. I also felt it was important the forum had a standardised approach to the format of its responses, so I contacted the two health boards to withdraw the forum's original submissions. Both organisations agreed to receive a revised response."

Start Quote

The National Clinical Forum were asked to clarify their stance on the specific proposals in the consultation document, which they have now done”

End Quote Mary Burrows Betsi Cadwaladr University Health Board

Dr Richard Lewis, Welsh Secretary for the British Medical Association, told Radio Wales it was difficult to understand how phrases such as "unrealistic and unsustainable" and "impending crisis" would need to be changed.

He said: "Those don't seem to be ambiguous or lacking in clarity to me.

"But if those sort of phrases were changed, that doesn't sound to me that that should be the right way for an independent body to be formulating its report, particularly in response to the people who are producing the plans.

"The other more worry thing is, if it's moving from a fair critique of the proposals to then being a supportive document, it's difficult to see how that is a clarification.

"It sounds to me to be more of a change in intention of the critique and I don't think that can be right."

In an message to NCF members leaked to BBC Wales, Mr Harmer said he had shared the decision to revise the submission with Mrs Burrows in private emails and that she was "very grateful for the more open support for the proposals" in the new draft.

'Confidence'

In a statement, Mrs Burrows said: "Discussions were held with the chair of the National Clinical Forum about their initial response to the consultation, which was received on 26 October.

"In it they expressed concern about the longer term sustainability of acute hospital services in north Wales.

"In our consultation document we did not propose to change these services at present but this was conditional on the ability to meet standards within the resources available.

"The National Clinical Forum were then asked to clarify their stance on the specific proposals in the consultation document, which they have now done."

The Welsh government said Health Minister Lesley Griffiths "categorically knew nothing about this chain of events" but has confidence in the clinical judgement of the NCF.

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