Analysis: Questions about independence of NHS report

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Ministers say a report by the respected health economist Marcus Longley "cements and underpins" the need for major changes to the way the health service is run.

But the disclosure of a series of emails between him and senior Welsh government officials raises fundamental questions about the document.

First of all, there appears to be a basic contradiction in the report's origins.

The Welsh government says the report was commissioned by the NHS Confederation, which represents local health boards, to articulate a national case for change - in effect to sell difficult reforms of the health service to a sceptical public. Its working title, The Case for Change, gives more than a clue as to its commissioners' intentions.

But by the time of the report's publication in May, both the health minister and the Confederation were at pains to stress the report was an entirely independent, impartial and academic piece of work. The report itself says it is designed so that people can make up their own minds about the need - or otherwise - for change.

Evidence

The title had now become the much more neutral The Best Configuration of Hospital Services for Wales - A Review Of The Evidence.

It is absolutely key to the credibility and authority of the report whether Professor Longley and his colleagues were sifting all available evidence and then coming to a conclusion, or searching for and choosing data to include in the report which fitted a pre-determined conclusion of the need for fundamental changes.

The confusion is added to by the tone of the exchanges between Professor Longley and senior Welsh government officials in the emails, released under the Freedom of Information Act. In many of the emails, Professor Longley is seeking data on health outcomes from the government to contribute to his report. He makes the point that the government were his only source of that up to date information.

But the way the emails are written gives the unmistakable impression that both sides are working hard to make the case as compelling as possible. In one, Professor Longley warns that "a crucial piece of the jigsaw... the argument 'we can't stay as we are: just look at outcomes' is 'so far, so elusive'".

A senior government official, Dr Chris Jones, advises him that the document "needs to be more positive if possible" and set out a more "persuasive vision".

For opposition parties, this disclosure raises major questions about the role of the government in the preparation of the report. As recently as last Wednesday, Dr Jones told the health committee that the report was "objective advice" to health boards and an "independent academic work".

But the greatest focus is likely to be on Health Minister Lesley Griffiths as her statement that Professor Longley's report was "completely independent" which "cements and underpins" reforms comes under unrelenting scrutiny.

With publication of health boards' plans for local service changes expected within weeks, it seems she now has a serious job of work to do in order to reassure people that the report designed to underpin those changes stands up to scrutiny.

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