Binning Bad News: Health Minister Edwina Hart 'withheld NHS report'

Welsh Liberal Democrat leader Kirsty Williams produced the document in the Senedd

Health Minister Edwina Hart has been accused of withholding a consultants' report which criticises the Welsh Assembly government's NHS leadership.

Welsh Liberal Democrat leader Kirsty Williams made the accusation in the Senedd, producing a McKinsey document.

Mrs Hart had previously said there was "no formal document for scrutiny".

The assembly government said Mrs Hart misled no-one, there was no McKinsey report, and the document was an example of "numerous inputs and analysis".

The consultants' conclusions were made public by Welsh Liberal Democrat leader Kirsty Williams during First Minister's Questions.

She asked First Minister Carwyn Jones how he explained "the existence of this report, which I have here, commissioned by his health minister, written by McKinsey and company".

She said the report described the assembly government's strategic objectives as 'too numerous and are not prioritised so that none or the wrong objectives are implemented'."

Ms Williams said the health minister had previously stated there was no McKinsey report and accused her of having "misled" AMs and the people of Wales by not publishing the "damning" report.

Mr Jones asked Ms Williams to write to him if she had any complaint about earlier statements given by the health minister. 'Five-year plan'

In a later statement, a spokesman for the Welsh Assembly Government said: "The (health) minister has not misled anyone. There is no McKinsey report. "

Edwina Hart did not mislead anyone, says the assembly government

The spokesman said the document produced by Ms Williams was "one such example" of "numerous inputs and analysis" which formed part of a five-year plan for the NHS.

He added: "The minister has been transparent throughout the whole process."

The McKinsey document made public by the Welsh Liberal Democrats identified criticisms of the way strategies have been implemented in the Welsh health service.

It said: "Our discussions have highlighted several reasons why strategy implementations have fallen short in Wales."

It noted:

• strategic objectives are too numerous and not prioritised, so none or the wrong ones are implemented
• a gap between policy leads and operational delivery
• strategic objectives are politically unviable
• implementation lacks accountability
• initiatives are financially unaffordable
• lack of capability to deliver
  

The document also made a number of recommendations to make savings. These included:

• prevent interventions of limited clinical value
• transfer cost of non-essential items items to patients (e.g nicotine patches)
• shut elective care over Christmas period
• require non-clinical nursing staff to cover shifts
• reduce staffing levels e.g overtime
• freeze pay spend (in certain areas).

Analysis by Vaughan Roderick Welsh Affairs Editor

The row that's erupted over the McKinsey analysis of the Welsh health service is basically a battle of semantics.

For the Welsh Liberal Democrat leader Kirsty Williams, it was an open and shut case. The health minister had denied the existence of a report by the management consultants in two written answers to AMs earlier this year.

Her industrious staff then unearthed a 60-page document written by McKinsey, which she flourished theatrically in front of First Minister Carwyn Jones.

The assembly government's defence is clear and specific. It is not a report, merely a document which was part of a much wider five year framework for the NHS as a whole.

In a sense, you pays your money and you takes your choice.

But document or report, Mr Jones looked uncomfortable, and it's an early political hit for the Lib Dem leader on the first day of the new term.

No administrators were culled during Welsh NHS restructuring

A storm erupted last night after it emerged that not a single administrator’s job was lost when the NHS in Wales was reorganised in October.

Although the number of Local Health Boards shrank from 22 to seven and dozens of highly-paid top management posts disappeared, no-one has been invited to apply for voluntary redundancy
or otherwise been forced to take it.

Welsh Conservative Shadow Health Minister Andrew RT Davies said:

We were promised NHS restructuring would deflate Labour’s bloated health service bureaucracy and refocus delivery on to frontline patient care.

People pay tax and National Insurance to receive first-class healthcare, not to bankroll administrators and bureaucrats.

David Rosser, director of CBI Wales, said:

This is a situation that a lot of people in the private sector and a lot of taxpayers will be angry about.

Nobody likes to make people redundant, but sadly there are times when efficiency savings have to be made.

It is inconceivable that a reorganisation along these lines could take place in the private sector without a reduction in head count.

This does not augur well for the savings the Assembly Government will need to make in the coming years.

The Assembly Government said:

We expect to see a reduction in management costs over time but this was never the primary purpose of the reform programme. The main savings of the reforms will result from reducing the transactional costs associated with the internal market.

The Greatest Show on Earth*

The winner of the race to succeed Rhodri Morgan as leader of Labour in Wales and first minister in the Welsh assembly will be announced later.

The result will be announced at about 1730 GMT at the Wales Millennium Centre in Cardiff Bay.

Eligible to vote are Welsh Labour party members, affiliated groups such as trade unions, and its MPs, AMs and MEP.

The candidates are all AMs, with Carwyn Jones widely seen as the front runner, followed by Edwina Hart and Huw Lewis.

Whoever wins is due to be confirmed as first minister just over a week later.

The two-month election campaign began formally when Mr Morgan confirmed on 1 October that he was standing down, shortly after his 70th birthday.

Mr Morgan has held the top job in Wales since February 2000, and said it was the right time to go.

In Mr Morgan's current cabinet, Mr Jones is counsel general, or the assembly government's chief legal adviser, and leader of the house, who is in charge of getting government business through the assembly.

The vote is split equally three ways between:

• Party members
• Labour-affiliated trade unions and other organisations
• Elected AMs, MPs and the party's one MEP for Wales.

Members voted by ranking the candidates in order of preference on the ballot papers.
If one candidate has more than 50% of the vote after the first round of counting, the candidate with the lowest number of votes will be eliminated and their second preferences transferred to the remaining two to decide the winner.

* just watch Facebook profiles, groups, and blogs disappear overnight.

A sign of things to come...

The friend or foe debate

The final Labour party debate between the three candidates hoping to succeed Rhodri Morgan as leader in Wales will take place in Cardiff later.

The winner, announced in December, will also become Welsh First Minister.

Health Minister Edwina Hart, Counsel General Carwyn Jones and and AM Huw Lewis will argue their case before party members at Cardiff County Hall.

The three candidates can also be seen going head-to-head on Dragon's Eye on BBC One Wales tonight.

Voting by Welsh Labour members, local parties, affiliated groups, MPs, AMs and its MEP ends on 26 November.

The victor is due to be declared at around 1600 GMT on Tuesday, 1 December.

But the winner will have to wait around a week after that before her or she is confirmed as head of the Welsh Assembly Government.

The Labour hustings meeting, following four previous events in Rhyl, Narberth, Newport and Swansea, is not open to the wider public or media.

A television audience will also be able to see them taking part in the BBC Wales debate in front of a public audience later on Thursday night. The programme was recorded on Wednesday.

Dragon's Eye Debates, chaired by Betsan Powys, is broadcast at 2245 BST on Thursday BBC One Wales.

Three leg race to replace a three legged duck

Perhaps there are simply three legs to any race, even if three's a crowd:

Leg 1: Speculation surrounding who will put themselves forward for leadership.

Leg 2: Hopefuls dropping out and rallying round their favourite.

Leg 3: One contender entering contest to draw support from one camp in order for another contender to sail through and win.

Don't look at me. You were also thinking it!

Hart attack: NHS 'spends £1bn of budget badly'

A billion pounds of the annual Welsh health budget is not being spent properly, according to finance chiefs. Full story here.

Welsh assembly members have been told that some patients are taking up beds needlessly, while others needed to be in hospital but were not.

Paul Davies, of the All Wales Directors of NHS, said a fifth of the £5bn annual health budget was not used correctly, with "extremely costly" mistakes.

The Welsh Assembly Government has been asked to comment.

Mr Davies told the assembly finance committee:

Far too many patients end up in the wrong place, either being hospitalised when they shouldn't be, or they stay in hospital too long, or they stay in primary care, and they should be in hospital.

All these mistakes .... [are] extremely costly, very expensive.

We believe there is at least 20% that we are not doing appropriately within the total budget, that if we did then we would see that improvement come through.

There's £1bn that we're not utilising appropriately.

Has the swine flu vaccination been adequately tested, or are we the guinea pigs?

A swine flu vaccination campaign will be launched in the autumn, but only certain at risk groups, including pregnant women, will be given the jab.

Those with underlying health conditions up to the age of 65 have been identified as the first priority in the UK followed by pregnant women.

Health and social care workers will also get the jab, meaning about 14m people will be immunised by December.

The government has yet to decide whether everyone should be given it.
There are contracts in place for 132m doses of the jab - enough for the whole population as people will require two shots.

One question. Speaking as a pregnant woman, is there any chance that the vaccine will be fully tested by this date? Only a thought!

Appealing to the masses

Just as one leader is about to make himself more appealing with the aid of voluntary work, another aims to make an appeal to the masses via a more direct appeal straight to the heart of party sympathisers (and mainly Welsh speaking).

N.B. No Labour AM has formally declared they intend to stand for the party's leadership. But Carwyn Jones, Merthyr Tydfil and Rhymney AM Huw Lewis and Gower AM and Health Minister Edwina Hart are all thought to be preparing campaigns.

Stay tuned but don't hold your breath over Summer.

Edwina Hart giving an interview (tick). Edwina Hart for First Minister (?)

Those of you that were watching BBC Wales' Dragon's Eye politics programme this evening experienced a rare treat - Edwina Hart, Assembly Member for Gower, and Minister for Health in Rhodri Morgan's Labour-led One Wales Government, giving an interview.

Edwina is a politician that likes, you could even say loves, getting stuck into any portfolio she's given, and with mixed success. It's hardly a Wales-wide secret that she loathes giving interviews. You could even say that she avoids them like the plague, or even an awkward announcement on health policy in South Wales. Sadly, she doesn't even prefer standing at the 'ministerial bench', and prefers to sit and read aloud notes during a plenary session.

Could it be that she's actually seriously considering standing for the Labour leadership?

Is Edwina pondering?

Wales Yearbook 2008 Political Awards Results (Pippa Wagstaff too shocked to return)

According to the Western Mail the winners of the Wales Yearbook 2008 Political Awards (sponsored by ITV Wales), are:

LORD Elis-Thomas, Presiding Officer of the National Assembly, was last night named Welsh Politician of the Year at a ceremony in Cardiff City Hall.

The former Plaid Cymru president got the award “for his role in the Assembly’s transformation into a true legislature, passing Welsh laws under its new powers”.

The citation went on to say: “As the Assembly’s first, and so far only, Presiding Officer, he has had no precedent to guide him – something he has seen as an opportunity rather than a problem.

“Dafydd Elis-Thomas has never been afraid to revise his opinions to reflect changing circumstances.

“A radical republican when first elected to Westminster at the age of 27, he has been keen to involve the Queen and Prince of Wales in the Assembly’s ceremonies as he works to weave devolution into the constitutional fabric of the nation.”

Other winners were:

MP of the Year: Paul Murphy.
AM of the Year: Edwina Hart.
MP to Watch: Jenny Willott.
AM to Watch: Andrew RT Davies.
Local Politician of the Year: Councillor John Davies, Leader of Pembrokeshire County Council and the Welsh Local Government Association.
Campaigner of the Year: Nerys Evans.

Dafydd Wigley, the Honorary President of Plaid Cymru, received a Lifetime Achievement award.

Elis Owen, National Director of ITV Wales, said: “We are delighted to support these awards, which are one of the ways that we celebrate the hard work politicians do for us in Wales.”

The awards will be shown on ITV Wales in a special programme on Thursday December 18 at 11.05pm, hosted by Wales Tonight’s Jonathan Hill and Sharp End’s Mai Davies. All winners received a personalised cartoon by Mumph and a bottle of Penderyn Welsh whisky.

Is it me or are some of the award results highly questionable and could be described as scraping the barrel? No wonder Pippa Wagstaff is on a break from blogging. At this rate she won't have the will to return!

Health Service: Judge, Jury and Executioner

The Minister for Health, Edwina Hart AM has been accused of a "personal takeover" in her latest reform announcement of the NHS. She had intended the organisations would be in place by April next year.

Mrs Hart is to to chair a new NHS Wales advisory board despite suggestions in consultation that an "arms length" body would be more appropriate. She said the board would meet in public and "the buck stops" with her.

SUMMARY OF NHS PROPOSALS:

• A National Advisory Board, chaired by the health minister, will be established
• A separate delivery board will also be created, chaired by the NHS Wales chief executive, responsible for the day-to-day operational performance of the seven new NHS local bodies
• Further work will be undertaken on whether the seven new bodies will be allocated some of the responsibilities of Health Commission Wales, the specialist commissioning body
• A unified public health organisation will be formed, with executive responsibility for public health being vested with the seven NHS local bodies and at a national level.
• A strengthened public health presence within local government

Conservative health spokesman Jonathan Morgan warned the advisory board would mean the "the politicisation of the health service in a way that I never thought possible".

"I do not understand why a government minister needs to be so involved in the day to day delivery of services,"

Liberal Democrat health spokeswoman Jenny Randerson said she completely rejected what she branded a "socialist model of the NHS".

Ms Randerson said the minister had "undermined the whole process of consultation by ignoring the wishes of those who responded to the consultation" by calling for a body that was a step away from politicians.

She accused Ms Hart of "going through the motions" and producing "the most centralising announcement in the assembly's history".

"I have immense regard for Edwina's energy and abilities but that does not stop me worrying hugely about the scale of this personal takeover," she said.

Not Nice

Matching up expensive drug treatments with limited funds is not easy. Today Anna Wolfenden published her open letter to the Assembly Government health minister about a cancer drug that is not yet available on the NHS. She is not the first to complain about the decisions of NICE, the body with the difficult task of deciding which treatments can be funded.

During debates of this sort you can always rely on someone to invoke the ghost of Aneurin Bevan by mentioning the 'principles of the NHS' (namely that treatment is free at the point of need). But health expenditure is going to simply carry on rising all the time - and faster than our ability to pay.

Are these 'principles of the NHS' really fit for twenty-first century healthcare purposes? Surely equitable health outcomes for all might be a better principle to aspire to rather than holding fast to a mechanism for delivery that was not planned with these expensive drugs in mind. Anyway, in England (and for the moment in Scotland) you have to pay for your prescriptions, so treatment is already not free at the point of need across the NHS.

Health gimmick taken up in millions

As the BBC and Western Mail have reported, the Welsh Assembly Gimmick Government's main gimmick - in order to make it stand out from Westminster - isn't quite going to plan.

The number of prescription items dispensed in Wales rose by 2.9m in the first year of free prescriptions, official figures show.

The number of dispensed items rose 5% from 59.1m in 2006/7 to 62m in 2007/8, the
equivalent to 20 items per person.

The chief medical officer said it showed there was more preventative work and more cancer drugs prescribed. But the Lib Dems said the figures proved their concerns of introducing free
prescriptions.

The figures follow a five-year general trend of an increase in items dispensed.

The National Statistics on GP prescribing showed the net cost of the prescribed items was £584m - an increase of 1% on the previous year - and equivalent to £188.90 per head.

Wales' £3 prescription charge was abolished in April last year by the Labour and Plaid Cymru run assembly government.

Wales' Chief Medical Officer Dr Tony Jewell said:

We know that in Wales we have more people with long term illnesses than England. These figures reflect the fact that more preventative work is being undertaken, with GPs prescribing medicines which are helping people manage their chronic conditions and keeping them out of hospital, reducing the cost and pressure on the NHS.

We are also issuing more medicines used to treat cancers, as cancer therapy has improved to a point where, for a number of patients, it is now a chronic condition, plus GPs are helping more patients with diabetes manage their condition under the new enhanced contract.

The figures also show we are increasing access while reducing costs. The net cost per prescription item decreased from £9.80 to £9.42.

But Welsh Lib Dem health spokesperson Jenny Randerson said:

We warned the (assembly) government that giving free prescriptions for all would be disastrous and today's figures have vindicated our position. A 5% increase (in items claimed) is disastrous when the (assembly) government is refusing to fund vital lifesaving drugs. The cost of this gimmick will be with Welsh patients for generations.

While millionaires claim their free paracetamol, the health service will continue to be to stretched to provide life saving services.

Shadow Health Minister Jonathan Morgan, Tory AM, said the figures showed people in Wales were becoming increasingly reliant on prescribed medicine:

The number of prescriptions being issued for cardiovascular problems for example has risen by 141.5% and these are often for the largest, most expensive items. Rather than micro-managing the NHS, the assembly government should be looking at improving the nation's health. Only then, as we become a healthier country, will costs fall.

Opposition politicians immediately said the figures were evidence that the Welsh Assembly Government’s flagship £30m-a-year policy had been a disaster. But doctors said the 2007-08 increases were in line with previous year-on-year rises in prescriptions in Wales and reflected the ongoing poor health of the nation.

End is nigh for NHS Bureaucratic heaven

NHS trusts and local health boards will be scrapped in Wales under radical plans to transform the way the health service is structured and managed.

Health Minister Edwina Hart today announced plans to replace the current 22 local health boards (LHBs) and seven acute NHS trusts with just seven new organisations which will provide both community and hospital-based health services.

If the plans are accepted - a further consultation period will start in the autumn - Wales will follow the same system adopted in Scotland and Northen Ireland. Mrs Hart said the proposals for integrated health boards come after an earlier consultation this year to reduce the number of LHBs and end the internal market in the NHS. Many respondents said NHS trusts should also be scrapped.

About time. Bureaucracy rules the roost in the NHS, in Wales. The fact that some NHS Trusts have to deal with more than one Local Health Board has added to the problem.

Health: Fears over security of NHS patients’ data

Jonathan Morgan AM, Assembly Shadow Health Minister has raised concerns following the Western Mail's disclosure last week that a Wales Audit Office specialist was sent on “gardening leave” the day before he was due to start an investigation into allegations that an NHS body called Health Solutions Wales had passed patient identifiable information to research company Dr Foster in possible breach of the Data Protection Act.

Contradictory statements about whether this confidential information relating to Welsh patients has been passed to a private company have led to a demand that Health Minister Edwina Hart should make an urgent statement.

Andrew Hurley, a £54,000-a-year IT specialist, has not returned to work since being sent on leave in October 2005.

Hugh Morgan, Director of Health Solutions Wales, told the Western Mail his body had not released patient identifiable information to Dr Foster. But he added, “Dr Foster does receive the equivalent information from England.”

Mr Morgan’s statement raised questions about whether patient identifiable information had been passed to Dr Foster relating to Welsh residents being treated in English hospitals.

Dr Foster issued a statement confirming that patient identifiable information had been passed to one of its departments by the Assembly Government. The statement said:

Imperial College has a PIAG (Patient Information Advisory Group) clearance to receive data from the Secondary User Service for certain research purposes. Under this clearance, Imperial College is permitted to disclose pseudonymised data to Dr Foster Intelligence.

Dr Foster does not hold patient-identifiable data – it holds pseudonymised patient-level data from English hospital providers which includes some patients resident in Wales.

The Imperial College Unit at Dr Foster were commissioned by the Welsh Assembly to do some research work and obtained PIAG permission to hold patient-identifiable Welsh data for this purpose. Dr Foster Intelligence does not have access to this data.

But the Assembly Government maintained Dr Foster had not been passed information which could enable patients to be identified. A spokesman said:

Neither Health Solution Wales nor Welsh NHS Trusts have released patient identifiable information to Dr Foster. In relation to Welsh patients with English providers, we have no evidence that this information has been released and therefore the Minister cannot comment, but we have initiated an investigation.

A spokeswoman for the Department of Health in London said:

There are strict procedures in place to ensure no patient identifiable data is passed from the NHS to Dr Foster. Dr Foster only has access to anonymised data.

Shadow Health Minister Jonathan Morgan, the Conservative AM for Cardiff North, said:

I will be calling for the Minister, Edwina Hart, to make an urgent statement on this matter. After a number of recent scandals, there is widespread public concern about the failure to protect confidential private information relating to individuals. The contradictory statements made on this issue means there must be a clear statement of the actual position.

Patients in Wales have a right to expect that their personal information will be protected by the NHS. If there is any question of passing identifiable information on to a third party, there must be a clear reason for it and people should have an opportunity either to give their consent for disclosure or to withhold permission.

At present the NHS is seeking to introduce a new computer system under which it would be possible for many health professionals to gain access to personal information relating to patients. Most people would probably support that so long as there are robust information-sharing protocols in place to ensure personal details are not disclosed inappropriately. But public confidence has been badly shaken by this series of disclosures. I don’t think there is now an appetite for the Government’s proposed national ID card.

Mr Morgan said he was also concerned the Wales Audit Office had apparently abandoned the inquiry that Mr Hurley had been about to undertake:

Although the WAO says its employee’s suspension was unrelated to the inquiry he was about to start, I find the circumstances highly suspicious. I would have expected the inquiry to be undertaken by another member of the WAO staff.

Homecoming Parade: from Basra to Cardiff

This morning the BBC and Western Mail have reported on the homecoming parade of The Royal Welsh.

Hundreds of soldiers have been given a heroes' welcome as they marched through Cardiff city centre to mark their return home from Iraq. About 450 soldiers from the 2nd Battalion The Royal Welsh took part in the homecoming parade.

Some 220 who had been on their first tour of duty in Iraq were presented with medals at the Millennium Stadium.

The parade celebrated the end of the tour of duty, and three soldiers who lost their lives were also remembered.

For the ceremony - hosted by the Welsh Assembly Government - the soldiers, led by the Lucknow Band of the Prince of Wales Division and a Warrior armoured tracked vehicle, marched from Cardiff Castle, along St Mary Street to the Millennium Stadium.

In front of their families, friends and members of the public, the Iraq medals were presented ahead of a lunch party on the pitch.

Three members of the battalion who lost their lives in Iraq - Cpl Paul Joszko, L/Cpl Ryan Francis and Pte Craig Barber - were honoured at the ceremony. Two other soldiers who died in Iraq while attached to the Royal Welsh from The Black Watch, 3rd Battalion The Royal Regiment of Scotland - Pte Jamie Kerr and Pte Scott Kennedy - were also be remembered.

Commanding officer Lt Colonel James Swift said:

We are very lucky to be able to mark our return to Wales in such style and pay a fitting tribute to our fallen comrades.

Congratulations to the Welsh Assembly Government for thinking of holding a parade in the first place, and more so to those returning, on a challenging job well done - Welcome home. My heart goes out to the families of the fallen as this is also a time to remember them, and that their contribution will not be forgotten.

Two surprises from my perspective:

1. Why wasn't the event better advertised so that more of the public could take part in welcoming our soldiers home, and pay respect to those who had lost their lives?


2. I never realised that Health Minister Edwina Hart, has responsibility within the Assembly Government for liaising with the armed forces and veterans. It might be a good idea to find out what other responsibilities each Minister holds in addition to their main ministerial role.