Key questions in NHS report controversy

The row is over the independence of a report into the future of the NHS in Wales, including hospitals

The disclosure of a series of emails between the academic behind an independent report into the future structure of health services in Wales and senior Welsh government officials has caused a political storm.

On Wednesday morning, Professor Marcus Longley will give evidence to the assembly's health committee, followed by the health minister and her officials.

Lesley Griffiths will then face a vote of confidence in the assembly later.

Toby Mason examines the key questions in the row:

1) What was the original purpose of the Longley report when it was commissioned back in January 2012?

This is absolutely key to the story - and remains a matter of contention.

It's still not absolutely clear whether the report, commissioned by Wales' seven Local Health Boards, was conceived as essentially a public relations tool to provide backing for the forthcoming changes to the health service, which are likely to be highly controversial, or whether they requested a genuinely impartial, academic survey of all existing evidence to inform the public of the backdrop to their plans for changes.

The NHS Confederation, which represents health boards, says the "overarching purpose" was to have "all the existing evidence collected in one place in an attempt to promote discussions and to inform the debate".

But at least one health board chief executive clearly believed it was proactively designed to make the case for change and convey the key messages of why change was needed to the public - with Welsh government involvement and backing.

2) What did Prof Longley and his team at the University of Glamorgan believe their brief was?

Again, this is fundamental to the row.

In his paper submitted to the NHS in December prior to starting work, Prof Longley wrote that he would "provide an impartial and independent synthesis of the most important evidence relating to the key issues on which the national case for change hinges".

However, we have still not seen the terms of reference for the work, or the actual contract signed for it to be carried out.

The opposition parties say that Prof Longley's emails, in which he appears to be requesting specific evidence from the government to support the need for service changes, calls this impartiality and independence into doubt.

He has strongly denied that this is what is behind the emails and today he will have a chance to explain to the committee in more detail.

3) Is there a discrepancy in what the health minister told the Cabinet in March - that the purpose of the report was to "articulate" the case for change - and what she told the public and AMs in May, namely that it was an independent, impartial and academic piece of work?

This is the fundamental issue for Lesley Griffiths to answer.

At a Cabinet meeting on 13 March this year she presented the emerging findings of Prof Longley's work, saying it had been commissioned by health board chief executives to "articulate a "national case for change" against the available evidence base".

The minutes indicate that the first minister endorsed the paper - particularly the case for change.

On the day of the report's publication, 9 May, Ms Griffiths said Prof Longley had "approached this study from a completely independent position and has drawn together the evidence as it is. He has no partisan position to promote. This report constitutes strong evidence from a clinical perspective - not a political one".

She added that the report was designed specifically "to allow readers to make up their own minds".

4) Did Welsh government officials see early drafts of the report and if so, why?

The answer to the first part of this question is "yes" - according to the emails, both David Sissling, director general of the Health Department and Dr Chris Jones, his deputy were being sent draft documents at intervals during the report's preparation.

The "why" is more difficult to answer - especially since throughout the process and after the report's publication, the health minister was keen to stress the report's independence from government.

One reason could be the somewhat convoluted lines of accountability between the Welsh government and the NHS in Wales - Mr Sissling is also chief executive of NHS Wales and Dr Jones, as well as being a civil servant, is also medical director of the NHS.

The health service as a whole clearly had a keen interest in the outcome of the report, as did the government, given the scale of the reforms in the pipeline.

5) What did Prof Longley mean when he referred to "we" in his emails?

This is the key question for the report author.

In his email to Dr Chris Jones of 22 February, Prof Longley writes "...on reflection the evidence as presented does not seem to be as incisive as we might have hoped".

He then asks for any further evidence that Dr Jones may be able to provide "to sharpen up the document and its impact in supporting the case for change".

AMs will want to know whether the "we" referred a shared aim between his team and the government, or his research team alone.

He will also face close questioning on what he meant when he said in another email that "killer facts would be really useful".

6) Did Welsh government officials have any influence on the final report?

It will be up to the health committee to decide whether they feel that Dr Chris Jones' request that the work be "more positive if possible" and set out a "a persuasive vision of how things could be better" did have an effect on the final report.

In one email, a civil servant offers Prof Longley access to figures for mortality rates - statistics showing a negative "weekend effect" of mortality in the health service featured prominently in the final report.

7) Did the health minister have any influence on the final report?

She has categorically denied this, and no evidence has emerged that she directly instructed either officials or the report authors as to the content of the report.

8) Is the health minister's position tenable?

Referring to the health reforms as a whole, she has said "the buck stops with me".

She has conceded that she knew her officials were in email contact with Prof Longley regarding the report, but has maintained that these were only requests for data.

More key will be her explanation of why she apparently cast the report in one light for the Cabinet in March and in a somewhat different one for the public in May, and AMs will no doubt be very keen to hear what she has to say on this.

However, it's unlikely the opposition parties will be able to win the vote of confidence - and it is not binding in any case.

She has received staunch support from the First Minister and her Labour colleagues since the row broke and this will continue.

9) How much has the forthcoming process of health service reconfiguration been damaged by this row?

The row has led to significant concerns behind the scenes within the health service about public confidence as each of the health boards prepares to unveil proposals for service changes.

Opposition politicians in north Wales claimed that Betsi Cadwaladr UHB cancelled a planned briefing on its plans last week as a result of the furore caused by the disclosure of the emails.

The NHS Confederation has acknowledged that the row has had an impact, saying it is "deeply disappointed" that the focus appears to have shifted from what it calls the "important debate" on service changes.

The first proposals are due from Hywel Dda health board on 6 August.

10) How much did the report cost?

According to the NHS Confederation, the cost was £29,000.

It was paid by Cardiff and Vale LHB on behalf of the other health boards - the Welsh government did not make any financial contribution.