You can't have it both ways...

Bronglais campaigners at the Senedd

It's made an appearance on this blog before - the sole issue, probably, that suggests there is such a thing as the third rail of Welsh politics. It is, of course, health.

Recently a senior medic - a man in whose hands I'd put my life with no hesitation - drew me a chilling picture of the future of the NHS. It wasn't a picture whose colours were political, not party political anyway. It was, as an art critic might suggest, from the school of Realism.

There won't be an NHS in a few years' time, he said. I give it until 2015. It's like watching a train speeding headlong towards a brick wall and it isn't even like watching it in slow motion any more.

What we have come to expect from a national health service, free at the point of delivery, he argued, just can't be delivered. There just isn't the money. There just isn't the expertise.

There just isn't the sort of vision needed to tackle it.

He volunteered only this: that in those circumstances, the only decisions that are truly worth making, that have an impact, are big ones, huge ones - and for huge read very, very brave.

This morning, protesters massed outside the Senedd, concerned that some big decisions are in the pipeline about services at Bronglais Hospital in Aberystwyth.

Mindful of the mounting row, the government's made a series of statements over the last 24 hours (written and oral) giving what they hope is complete reassurance to those protesters, and aimed at damping the political attack being pursued by primarily Plaid Cymru, but others too.

But hang on. You can't have it both ways can you?

The Health Minister has been at pains to say that individual hospital reconfiguration plans currently being drawn up are a matter for Wales' local health boards, and emphatically not for her.

Here's Lesley Griffiths in front of the Health Committee on January 25th, talking about the reconfiguration process:

"Some Members seem to think that I should be there at the beginning, but I should not. I am there at the end. I set the direction, and it is up to the local health boards to plan services for their local population and ensure that they are of a high quality and are safe and effective."

Here's the minister responding to questions on February 1st about her refusal to be drawn on the future of Bronglais hospital:

"I am very happy to meet elected representatives to discuss the aims of 'Together for Health' and the policy. What I am not happy to do is discuss what I was asked to discuss, namely cuts and changes. I do not know what is being proposed in terms of cuts and changes, therefore I cannot discuss things I do not know about. Now is the time for the local population and elected representatives to get involved."

This morning's BBC radio bulletins carried reports of the protest march at the Senedd today by those concerned about the future of Bronglais. They also included a line from Hywel Dda LHB saying they were listening to what the the people of mid Wales were telling them and stressing no decisions had been made yet.

But the Welsh Government was so keen for their line on the future of Bronglais to be carried that they issued their own statement in the name of the First Minister, saying:

"I understand how strongly people feel about their local hospital, and that is why I am deeply concerned that people are being given false information which is causing unnecessary concern and unease amongst the immediate and wider community the hospital serves.

I would like to make it perfectly clear;

There are no plans to close Bronglais hospital.

There are no plans to downgrade Bronglais hospital.

District General Hospitals - like Bronglais - will continue to be District General Hospitals.

"Our commitment to Bronglais is clear - and reinforced by the £38m investment we have made in the hospital over the past few years.

"Our five-year vision for the NHS in Wales, Together for Health, demonstrates our commitment to ensure we have safe, sustainable services of the highest quality across Wales."

So far, so clear.

But at the same time, how can the government stand back and say decisions on service reconfiguration are nothing to do with us, and a matter for Local Health Boards - and yet issue formal guarantees of the future of services at individual hospitals which happen to be the focus of intense political and public scrutiny?

Incidentally, one who seems to need some reassuring is Labour councillor and Aberystwyth mayor, Richard Boudier, part of today's protest march, who's told BBC Wales it is important the NHS evolves, but the health board's plans were both "life threatening and dangerous".

The Government are perfectly within their rights to point to multi million pound investments underway at Bronglais as evidence of their commitment to facilities there.

But unless Lesley Griffiths has written to the chair of Hywel Dda to tell him unequivocally that any service changes at Bronglais are off the table for the foreseeable future, then isn't it hard to see how the government can make public statements to that effect with confidence?

The government's irritation would be more understandable if concerns about services at Bronglais were a purely political confection, as Carwyn Jones chose to portray it at First Ministers Questions yesterday in a sharp exchange indeed with Elin Jones.

But they're not. In summer 2010, Hywel Dda LHB issued a working document, hurriedly rescinded, which indicated a downgrading of services at Bronglais and a centralisation of services at Glangwili in Carmarthen. In their replies at the time, the government indicated this was an "operational matter" for the LHB.

More recently, the vast majority of consultant medical staff at Bronglais signed a letter expressing their lack of confidence in the board of Hywel Dda to support them in delivering services locally.

Now as with all political rows, there's an element of the feedback loop going on here, with concerns echoed and amplified between politicians, clinicians, the media and the public - but twas ever thus surely?

We've asked Hywel Dda LHB press office to ask what firm published plans are currently in the public domain about the future of Bronglais Hospital. They've pointed us to this link on their website, but stressed that "no decisions" big or otherwise, have yet been taken.

**UPDATE** Lesley Griffiths has just said this on Bronglais during her response to the Plaid Cymru debate in the chamber this afternoon:

"A question has been asked as to how I can state that no services will be downgraded when I have said that any future plans are the responsibility of LHBs and as yet these plans are yet to be fully developed.

"The answer is very simple.

"As Minister I am in continual contact with my Chairs - I met the Chair of Hywel Dda on Monday and he has told me the direction of travel in terms of the future plans and stated that in terms of the services I have listed and I have had correspondence on are fundamental to the future of Bronglais Hospital and not part of wider service change plans in Hywel Dda."