Over-rule on the cards on health?


Could the Welsh Government be planning to intervene in the bitter - and escalating - row over neonatal intensive care in North Wales?

There are increasing signs that ministers are spooked by the sheer scale of the row over the Betsi Cadwaladr UHB plans to transfer new babies needing the highest level of treatment out of North Wales and to the Arrowe Park hospital on the Wirral.

The health board is facing a concerted cross party campaign to reverse its decision. Protesters were dismayed last week when patient watchdog the Community Health Council decided not to use its powers to refer the move to the Health Minister to make the final decision and potentially over-rule the UHB. Many now feel it's a done deal.

But are they right? Perhaps not.

There is certainly significant anger about the CHC decision not to refer the neonatal plans. Several senior politicians in the region have questioned the point of having a patients watchdog at all if it fails to reflect the local strength of feeling on such issues. Remember the CHC is the sole organisation which has the power to refer change plans to ministers. But it may not be the "last shot in the locker" as some fear; remember the Welsh NHS is a wholly-owned subsidiary of the Welsh Government and the Health Minister ultimately calls the shots.

The pressure on her is now intense. Labour councillors locally are bitterly opposed to the decision. The Labour AM for the Vale of Clwyd, Ann Jones has signed a letter of protest alongside AMs from the three other parties - a rare event indeed. The issue has been discussed at Cabinet level.

Ministers are uneasy about the move on several fronts, some related to the degree of opposition within their own party, others to the strength of local feeling, including the Daily Post campaign, and the precedent of actively moving the service out of the Welsh health system and into the English one.

Until now, the Welsh Government has always said it cannot say anything on any health proposals because of the quasi-judicial role that ministers potentially have, if plans are referred to them for decision. Just that has happened in the case of many of those put forward by the Hywel Dda LHB.

But at health questions this afternoon, Lesley Griffiths went far further than she ever has before in discussing the plans in public. While emphasising the need for "due process", she acknowledged the volume of correspondence opposing the move, much from people whose opinion "she greatly respects". Crucially, she confirmed that she reserved the right to call in the decision herself. Sources suggest the minister, under pressure, is coming round to this approach.

Speaking at First Minister's Questions yesterday, First Minister Carwyn Jones said, "Should we be over-reliant in the future, and this is a general point on a health service in England that is being wrecked and privatised? I think that is a fair point and one which will need to be considered in its entirety when we consider the future of the health service in Wales as a whole".

There in a nutshell, is the Welsh Government's dilemma. Mr Jones spends a considerable amount of time suggesting that the English NHS will go to hell in a handcart in the coming years as a result of the UK Government's reforms. If he really thinks that, why then, ask opponents of the change, is he comfortable to export the sickest and most vulnerable newborns in North Wales directly into that system? There's no easy answer to that.

One possibility is that the Health Minister will allow the board to transfer services to England - but place a time restriction of perhaps two years on it, while in the meantime ordering Betsi Cadwaladr to build up an indigenous service in Wales. The main problem currently is said to be throughput - that is, there aren't enough babies requiring the high level of care in the region to make the service sustainable. A new system would need to overcome this and of course, find some extra money.

A decision by Lesley Griffiths to over-rule Betsi Cadwaladr UHB on the neo-natal issue would be strongly welcomed by those who have been campaigning against the transfer to the Wirral. But the precedent, particularly if it is done pro-actively by the Minister, rather than resulting from a CHC referral, isn't great for the Welsh Government to put it mildly.

First of all, it hangs the health board out to dry. They've said publicly on numerous occasions that there is no safe and sustainable solution for this kind of care able to be provided in North Wales. The Welsh Government would presumably have to find an answer that has so far eluded the BCUHB chief executive Mary Burrows and her colleagues, who have taken immense flak on the Arrowe Park proposal for months.

But such an overrule would have national implications, with equally unpopular reconfiguration proposals already finalised in West Wales and soon to be published for a number of health boards across South Wales.

What does it say to those boards gearing up for a bare-knuckle fight with local protesters if this controversial decision by Betsi is reversed by the Health Minister, however great the pressure on her?

You'll note the question mark in the headline - nothing is clear but keep watching this space.

Betsan Powys Article written by Betsan Powys Betsan Powys Former political editor, Wales

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  • rate this

    Comment number 48.

    ... I believe your logic is flawed #47, the electorate, although important democratically, are probably unqualified to make the necessary judgements in the provision of healthcare across the region.

    Better an affordable plan than the "wants" (rather than "needs") of the town and its council.

  • rate this

    Comment number 47.

    Local views on the health of the electorate are critical - their concern represents the care of the people in the area and the NHS meeting the needs of the people of the area. The electorate will also remember the actions of those who are trying to force their views which appear to be based on finance rather than health concerns in future ballots. If you care remember those in need of health care.

  • rate this

    Comment number 46.

    Not very nice Celt for any one who has lost a baby in English or Welsh Hospitals. To make a mockery of it to score a point is the lowest you can get.

  • rate this

    Comment number 45.

    #43 ' HD CHC who truly represented the patient voice. '
    The trouble with the patient voice is that they are quite logically concerned with their immediate treatment and convenience; and little concerned with cost and longer=term issues such as training, career development and sustainability. E.g the famous habit of collecting for, and buying, an NMR scanner, but no funds raised to run it.

  • rate this

    Comment number 44.

    Let me explain this very slowly so you can keep up: NEONATAL SERVICES IN NORTH WALES AREN'T SAFE and WE CAN'T AFFORD TO MAKE THEM SO. Simples, surely?

  • rate this

    Comment number 43.

    Thank God we have Hywel DDA CHC who had the guts and backbone to refer Hywel Dda LHB proposals to the minister. We the people are proud that we have a body like our HD CHC who truly represented the patient voice. Betsi Cadwaladr CHC should hang their head in shame, they have let the patients in north Wales down badly!!

  • rate this

    Comment number 42.

    Keep out lovely Welsh babies away from those ghastly English people. If they die then at least they die in lovely Welsh hospitals surrounded by lovely Welsh people amongst the lovely Welsh countryside. How much longer is this delusion going to continue?

  • rate this

    Comment number 41.

    If it is about cost why are they moving GP surgeries into PFI type buildings?, to enable this to to pay Local Council and Health Board are having to take on 20yr leases, staff will be delivering services from them against the wishes of those customers who would rather see them delivered from where they are now.

    This is going to create similar issues to the Dyfed powys police station fiasco

  • rate this

    Comment number 40.

    Griffiths should call in the decision now and confirm that Flint Cottage Hospital is to be downgraded. We can expect to see the same protests about each and every closure/downgrading. Time for the WAG to be honest about the future of the Welsh NHS and to provide leadership? Yes it is but will that happen

  • rate this

    Comment number 39.

    31 fuel at £10gal whose pay the bill Us of course,demographical we are near the end game,ageing pop and young skip abroad for work,signs of weakness.
    we need to power up our country,and aim 4 selfsuffiency,in food, and power and liberty.
    we have to develop all method of empowerment, to keep resource local,green up and renewables,Sharpe make solar panels in wrecsam put one on every roof in wales

  • rate this

    Comment number 38.

    'Safe and sustainable', those are the key words and this is a horrendously difficult decision. Under no circumstances would we want to see a re-run of the Bristol baby heart surgery tragedy where poor outcomes were seen for years but ignored all the way up to the NHS head honcho. The cause? Not enough cases for a safe level of expertise in the required number of surgeons. So, be aware.

  • rate this

    Comment number 37.

    #26 'no direct bus route to Holywell or Glan Clwyd (hospitals).
    The idea that, , is the economics of the madhouse. Don't lobbby the Health Minister. Lobby the bus company ! If necessary a subsidy for a bus to accord with visiting is still more sensible than building another small DGH.

  • rate this

    Comment number 36.

    John Tyler, the issue of Flint Community hospital is important to the people of Flint, our town is growing in population by the month and with over 600 more homes being built at this moment, recuperation and end of life care is what the Flint people need and its not just a case of having to travel, it where to travel to. Hospitals in the nearby towns are filled. Our 14 beds were much needed..

  • rate this

    Comment number 35.

    ... the issue of the Flint Community Hospital, is it a hospital, is bordering on hysteria, its a 14 bed GP led operation, it specialises in rehabilitation, care of the elderly, palliative and terminal care. If there is any serious issue the patient is taken to an appropriate hospital.

    The outpatients facility should be with the specialist, the other 4 services provided by GP practices.

  • rate this

    Comment number 34.

    Sandie Mewis who is Flints am wont even reply to any letters sent out to her regardind Flint Hospital she wont come to Flint to discuss the matter what is the point in having her if we cant voice our concerns to her

  • rate this

    Comment number 33.

    Flint Town Council have agreed to a VOTE OF NO CONFIEDENCE with the health board as they dont agree to their decisions

  • rate this

    Comment number 32.

    Flint Cottage Hospital has just recently been shut and its already causing caos with the Doctors as they have been told not to refer any patients to Glan Clwyd Hospital as they cant cope
    Flint Cottage is a well run hospital never been shut and is alot cheaper to run than sending patients to the larger hospitals
    The Health Board have shut Flint Hospital earlier than agreed

  • rate this

    Comment number 31.

    Labour politicians runing scared of taking the decisions they should have taken years ago. Apart from clinical effectiveness,staffing,or financial impacts of running small units that can't maintain doctors skills what about the changes in communications. Fast roads give easy access across north Wales, emergency helicopterss even faster. Consultants driving round in cars are not treating patients.

  • rate this

    Comment number 30.

    yes years of financial robbery by succesive goverments have left little old wales busted,every pound diverted to england and not rightfully given to wales doubles down on us,300million a year + = 600million extra spend in rest of uk,let down as usual by our elected reps even if u have never voted from them.no money no control, time to take the gloves off before the demographics end wales forever

  • rate this

    Comment number 29.

    ... #28, living in the South East we live with the situation you describe for the "72 year old woman who's lived in Flint all her life".

    Living in Caerphilly we lost our Miners Hospital to a new Ystrad Mynach Hospital, for complex conditions we travel to Newport, we don't have hospitals convenient for all, our LHB has cut its cloth well, why not give yours a chance to do its job !


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