Velindre: Email exchanges towards truth.

Background to Email correspondence regarding Code of Conduct

At a historic meeting of Senedd’s Health & Social Care Committee 30^th September 2020, Welsh Government (WG) responded to the concerns of many clinicians working in cancer that no independent, external clinical review had ever scrutinised the proposed cancer centre standalone model. This was the heart of the issue raised at that meeting with safety being just the most pressing aspect. From this point, WG claimed on several occasions that the Nuffield Trust panel was commissioned to review the cancer centre model.

This claim endured into September 2023, stopping only when challenged by our email. The email trail below starts at around this point: ‘You have raised concerns associated with the proposed new Cancer Centre. The appropriateness of the proposed clinical model is something that has been raised on previous occasions and has been independently reviewed by the Nuffield Trust. The Welsh Government will continue to oversee the new Cancer Centre proposals etc.’ (We leave aside here a seeming superior tone of correction which itself turned out to need correcting.)

The ensuing correspondence below, is re-ordered for easy chronology, and seen by many politicians and stakeholders and its faithfulness to the original thread assumed and not challenged. 

THE EMAIL EXCHANGES: COLOCATE VELINDRE & DEPARTMENT OF HEALTH & SOCIAL CARE September-December 2023 (non-WG email addresses redacted)

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Velindre: Complaint lodged with the First Minister

Dear First Minister,

We understand that any claim of breach of the Ministerial Code of Conduct goes to the First Minister, hence this letter comes before you now. It is uniquely marked by gravity and absurdity at the same time. This is because it raises the question of you yourself breaching the code when Health Minister, but incongruously finds you made arbiter over yourself by appointment to your new role.

At first, our correspondence with you of September to December 2023 merely pressed you as Health Minister to correct false information issuing from you and other ministers. We just sought a full, official, public retraction of a false narrative regarding the new Velindre Centre’s legitimacy.

Unfortunately, you went no further than a partial, and even contradictory, response, and added what we perceived as further breaches. We still await a reply to our closing evidence or an unqualified, public retraction. Until then, we see the infringements as live and active even now.

However, with political uncertainty ended over the First Minister’s office and cabinet, we feel justified in taking this extra step of an official complaint now. The questions of fact are not trivial, since they concern at least £1bn of precious cancer money splashed on a cancer centre model belonging in the past century. It is a record Welsh NHS capital debt for an asset that is shrinking.

In brief, evidence from the correspondence shows: 1) that you erroneously assured a correspondent that the decision for the new Velindre’s contentious clinical model (i.e. a centre away from a major hospital), was reviewed by the Nuffield Trust, 2) that your substituted version was nevertheless just as misleading. It still opted to say erroneously that the cancer centre model was ‘subject to the Nuffield Trust’ and 3) yet more erroneously, that you’d never raised the cancer centre model with us at all. We unpack these claims below (also in the file attached).

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Velindre: Investigator/Colocate Velindre Exchanges (in chronological order)

david.richards@gov.wales

Tue, 8 Oct at 08:00

Dear Dr. P Owen and Dr R Kearsley (O.B.O Co-locate Velindre),

The First Minister asked me to consider your message to her of 26 August raising a complaint that she had broken the Ministerial Code of Conduct.  I am the Director of Propriety and Ethics and I advise the First Minister on matters in relation to the Ministerial Code.  As a civil servant, I do so in accordance with the civil service values of objectivity and impartiality.

I have read carefully the exchanges between yourself and the Welsh Government which you included with your complaint, together with the covering email setting out your concerns.   I have also discussed the issues with the policy team from our health department who have been advising on these matters.

I appreciate that decisions about the future structure of cancer services are very important and emotive, and that there has been a lot of controversy and debate about the decision in relation to Velindre.  But I have, of course, confined my consideration to whether there has been a breach of the Ministerial Code in the statements that have been made to you.

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Velindre: Summary on handling of the Complaint

Informed by the coinciding 2^nd October 2024 meeting of the Senedd Public Accounts and Public Administration Committee (PAPAC). 

This picks up where the following news report left off:

https://nation.cymru/news/eluned-morgan-told-to-investigate-herself-by-hospital-campaigners/

As a campaign group Colocate Velindre has discovered the obvious. Any ethical code, however excellent, is only as good as the quality and robustness of its supporting complaints procedure. How well, then, did it perform with our Complaint?

• On timeliness, the Propriety and Ethical Team (PET) took 7 weeks to acknowledge its receipt of Colocate Velindre’s official Complaint, and then only did so in the final rejection letter. By remarkable coincidence, this occurred only one week after PAPAC raised questions on PET’s procedures with the very official to whom PET reports. 

• Colocate Velindre’s story illustrates how the ‘normal practice’ described at the 2^nd October meeting by the Permanent Secretary is so easily open to serious conflict of interest. PET’s one and only letter disclosed the First Minister’s approach to her own alleged breach of code in her health secretary phase. Now in her new power and duties, she apparently saw no special ethical obligation. Hence she by-passed the option to refer the Complaint to an external investigator. Instead she put it across to an internal investigator answerable directly to her own Permanent Secretary.

• But it does not end there. The Director’s letter to Colocate Velindre, when rejecting the Complaint, claimed to have subjected it to a final approval from the First Minister: ‘I have given this advice to the First Minister, who has accepted it, and has asked me to write to you to convey my findings’. 

In short, she here retains management of the Complaint, end-to-end, ignoring the obvious and available option to refer externally. She marks her own homework and signs it off, an entitlement enjoyed by her alone This, apparently is an example of the civil service ‘impartiality’, repeatedly claimed by the Permanent Secretary at the 2^nd October meeting. 

• None of this is the Complainant’s doing but lies with the First Minister. She could have asked PET to appoint an external investigator (2^nd October meeting paras 26, 63, 68 etc), accepting whatever verdict would ensue. Instead, her action strengthens original suspicions of infringement by false claims of clinical excellence for a new Velindre allegedly ‘reviewed’. 

• There are other serious concerns evident from the Director’s letter. For one thing, he claims to have read the correspondence at the heart of the Complaint, yet leaves no evidence of such knowledge. 

For example, that 2023 email exchanges had cited evidence making it impossible to believe that the announcing of a ‘clinical review’ of Velindre was a mere ‘honest mistake’. That ‘mistake’ had too long a history at the highest level for that to be the case. The Director’s letter shows no awareness of this hurdle, let alone of his duty to dispose of it in his investigation. 

• Equally, in the 2023 exchanges, she blurs the difference between a management model for the new cancer network and a ‘standalone’ model for the cancer centre itself. In context, the effect was to pass off Nuffield’s approval of the network as approving also the contentious choice of cancer centre model. But the Director seems unaware of this crossover, despite the correspondence having critiqued it. 

• Hence, Colocate Velindre was forced to highlight further the PET decision’s deficiency: ‘your [pivotal] statement… presupposes the cancer network as the shared topic in the email exchanges, whereas only one side, under pressure, introduced this view… What’s more, no grounds are offered for this preferential supposition which underpins your whole case. This means the unsupported assumption nullifies the impartiality of the entire investigation.’

• Finally, the Colocate Velindre reply found it also necessary to add: You say only that you discussed the issues with the policy team from the health department. This is a somewhat unbalanced and limited range of witnesses. The health policy team has been deeply involved in producing the emails we have had to challenge, a participant not an impartial witness. You and PET, therefore, have illustrated why expert advice recently given to PAPAC at Senedd insists that policy advisors should not also oversee or conduct investigations.¹

¹We would add questioning of claims for PET’s being an ‘arms-length’ handling. We suggest, a very short arm indeed. Tightly fixed at both ends. Perhaps, better, ‘a finger tip’s length’, since the PET director is accountable straight to the Permanent Secretary, the head of the civil service whose responsibility is to closely support the First Minister. 

Many people know that senior cancer clinicians wrote twice to Welsh Government about the plans for the new Velindre Cancer Centre. They asked for an independent clinical review.

https://colocate-velindre.co.uk/clinical-letter-to-ministers-7/

Those clinicians (57 signed the first letter, 163 the second) worked in the Health Boards whose patients travel to Velindre for radiotherapy and chemotherapy.

Velindre clinicians also wrote

There are other, less well known letters. This time from clinicians in Velindre themselves, spelling out their concerns about the Velindre plans. Again, asking for an independent external review. They wrote to Welsh Government Ministers and Officials, as well as their own Chief Executive and Medical Director:-

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https://www.youtube.com/@protectingourhealth7043

This is the new Velindre Cancer Centre, and NHS Wales is sinking £800M of public money into this obselete development against the advice of 200 cancer specialists [and expert panelists].

email addresses:
correspondence.eluned.morgan@gov.wales
correspondence.mark.drakeford@gov.wales
INCLUDE THE WORD ‘CORRESPONDENCE’ AS PART OF THE EMAIL ADDRESS.

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RE. The persistent and on-going attempts to gain access to our website, most notably since recent articles in the Welsh media have shone the spotlight on the very serious issues we have raised. These many hundreds of illegal access attempts every day are being noted and our legal representatives have been informed. Further unscrupulous attempts to gain control of our website in an attempt to stifle our freedom of speech, will be publicised widely on social media and the press for the public to draw their own conclusions as to who is responsible.

We will not be silenced.

Team Co-locate

Dear Acorn. Our medical campaign wishes to share with you information that is professionally and morally important to you. We are not a fringe group. Our views align with the dominant clinical cancer expertise throughout the world. The real fringe view is that which deviates from this best practice, namely New Velindre.

• The World Health Organisation’s 120-page document Setting Up a Cancer Centre (2022) makes clear that new cancer centres, including day treatment units, must be located on hospital sites.

• By going against leading expertise, New Velindre invites ridicule from international health groups, however ‘green’ the build claims to be.

• Controversy around the site and model in 2020 forced New Velindre to take advice from the Nuffield Trust (terms of reference and funding provided by Velindre – access the report below). Velindre alleges that the report approved the planned long-term infrastructure at Whitchurch. However, Nuffield did not say that the current planned build should go ahead.

• Velindre’s quote misconstrues Nuffield’s words, wrenching them out of context:

‘[Nuffield] advised that collocation would not be an option for some considerable time. It also emphasised that solutions to the immediate issues facing cancer services were ‘required now rather than an indeterminate point in the future. [It] concluded that with the implementation of its recommendations, the proposed model for tertiary cancer services in south-east Wales would ‘offer a safe and high-quality service’.

• What the Nuffield press release actually said in order to make clear its recommendation here was: ‘With some adjustments, including locating inpatient care for patients at risk of major escalation at relevant local acute hospitals… and co-locating a cancer research and trials hub with inpatient beds at University Hospital Wales, the proposed network model supported by a new cancer centre offers the potential for a safe and high-quality service that provides a good patient experience.’

• Notably it’s only a potential not a certain outcome. Moreover, the passages from Nuffield quoted by Velindre focus only on the ‘immediate issues’, namely patients at risk of deterioration in the current Velindre. And it stipulates that these will require admission to acute hospitals, especially University Hospital Wales. In fact, this stipulation marks the beginning of co-located care. Hence it does NOT refer to the planned new build.

• What’s more, the number of such patients at risk will increase with available new treatments. Nuffield here gives no approval of a long-term ‘stand-alone’ cancer unit but approves what is only a ‘reasonable way forward’, including ongoing work towards a more future-proof solution on an acute site in the coming ten years. The currently intended building to serve for decades is therefore a wasteful, over-the-top response to advice meant only as immediate measures.

• Moreover, the Nuffield report elsewhere made very plain that only research based at an acute hospital site can be the ultimate driver of world-class cancer excellence. Just as WHO’s manual has also made plain.

• Nuffield did not say that the proposed network will transform cancer services. Because they know it won’t. Not without a co-located hub at an acute hospital for world-class cancer research and treatment.

• When mentioning ‘flexible design’, Nuffield did not say, ‘just get on and build it here anyway and you can always get some kind of “change of use” afterwards’.

• However, it did stress that choice of site could only be made through a large-scale options appraisal. But Velindre never did this in 2014, nor got it done post-Nuffield. See definitive links below, especially the first one.

• Nuffield did not give reassurance to the residents of Cardiff and its environs. These many South-East Wales residents will lack a local comprehensive cancer therapy service sited at a general hospital. All stakeholders are complicit in this provision of substandard care.

• If you think we exaggerate, why not get a third disinterested opinion? Ask clinicians working in cancer outside Wales about the advisability of building a brand-new cancer unit away from a hospital setting.

• Lastly and most importantly, we respectfully urge you to familiarise yourself with the WHO report in the interest of protecting your established professional reputation: Setting Up a Cancer Centre: A WHO–IAEA Framework | IAEA

Our campaign through the blog Co-locate Velindre – Supporting Best Cancer Care, will continue even if this cancer unit is built, whatever other campaigns choose to do. This is because it’s a fight for best cancer care. The case for co-location is primarily about the siting of cancer services so will continue to have prominent media coverage just as it has already. This will still oblige us to focus on what some locals already call ‘that Acorn white elephant.’ To which might get added: ‘those developers who took the money that might have given us a quality cancer service.’

Respectfully,

Co-locate Velindre

Nuffield Trust report: Nuffield Trust publishes report on cancer services in South East Wales | The Nuffield Trust. See especially pages 3, 37-39

Nuffield Trust Press-release – https://www.nuffieldtrust.org.uk/news-item/nuffield-trust-publishes-report-on-cancer-services-in-south-east-wales-1

See some disconcerting links regarding the missing, initial, appraisal process (even yet not corrected):

See especially the update of a January 6th 2022 blog

Where’s New Velindre’s large-scale options appraisal?

Jaguar Electric v Rickshaw?

and

Nuffield Myths. Always look twice.

and

Freedom of Information – but ‘where are the Velindre minutes?’

See also recent newspaper reports:

https://www.pressreader.com/uk/western-mail/20221008/281827172662311

https://www.walesonline.co.uk/news/no-records-exist-meetings-set-24499250

[This presentation of the letter follows the original closely but is an electronic version, includes a few minor edits for a blog and adds three further links]

Where’s New Velindre’s large scale options appraisal? Yes, at the time of this blog updated from January, that spectre’s still haunting New Velindre. In December 2021 Colocate Velindre contested a local politician’s claim about the Nuffield Trust’s report to Velindre in 2020: https://colocate-velindre.co.uk/nuffield-myths-always-look-twice/. The claim was that ‘Nuffield said the build should go ahead’. This assertion was a fiction.

The politician had just not grasped the significance of Nuffield’s insistence on a large-scale options appraisal. It preceded and determined everything else in any major process of clinical change. The words are strong, surely because some lack was suspected. So, it wouldn’t and couldn’t say ‘go ahead’:

 ‘…we are not making any judgement about the decision to site the new VCC on the Northern Meadows. Such a large-scale option appraisal exercise is not only well beyond our terms of reference but is fundamentally about values and the choices that need to be assessed and taken by all involved.’ (p.11)

Further points appeared in the original version of today’s blog on the 6th of January. These are updated here too:

The obvious implication

The public have still been told nothing about who initiated, concluded and sealed this exact location detail. Hence one thing is sure. With such invisibility nothing ‘large-scale’ can have taken place.

So New Velindre cannot simply go on ignoring its non-compliance with this condition, especially when presenting itself as a follower of Nuffield. To see Nuffield’s wisdom proven beyond doubt see: https://colocate-velindre.co.uk/jaguar-electric-vs-rickshaw/

The obvious implication now set in stone

To repeat the question, where’s New Velindre’s large scale options appraisal? Our original post noted a New Velindre fog around the NHS requirement for a large-scale appraisal. But we couldn’t foresee what would happen a few days later. New Velindre, in a Freedom of Information email reply, now reported that no evidence ever existed for any such groundwork exercise.

Shockingly, it holds no records, e.g. minutes, for the biggest deliberations in its history informing and empowering the main driving decision. An undocumented process had determined the destiny of New Velindre and ultimately its £562m + final price-tag. In particular, that destiny was the somewhat antique, ‘stand-alone’ model underpinning everything (i.e. built away from an acute hospital). All alleged decision-making for this is undocumented, unofficial and invisible. For the full story exposed, visit:

Freedom of Information – but ‘where are the Velindre minutes?’

What it all means

From the above we see that the Nuffield panel had found a way of raising this exercise with New Velindre, surely on the suspicion that the requirement had not been met.

But even now New Velindre’s leaders continue to ignore the matter while loudly claiming to follow Nuffield. It’s a misleading claim. No wonder the January 2021 letter from 163 senior clinicians (snubbed twice by Welsh Government) had stated: “There must be a formal review, including an updated, full options appraisal…This can be done at pace.” https://colocate-velindre.co.uk/letter-from-163-clinicians/

Action

The first version of this blog urged the Minister of Health, Senedd Health Committee, shadow ministers and Senedd members to reassure us of sound procedures and foundations for the New Velindre programme. In fact, the Health Committee did indeed ask for clarification regarding the astounding disclosure. The end result left New Velindre itself confirming the truth of our blog. In a further, even more shocking, response it confirmed there were no records, and none were needed! https://www.walesonline.co.uk/news/no-records-exist-meetings-set-24499250

It’s a sentiment that can’t be squared with what Nuffield had spelt out so clearly. Surely this New Velindre precedent, and the hubris and audacity lying behind it, matters hugely to cancer care in all of Wales. In fact, all health care in Wales. Perhaps even all government spending in Wales.

A Senedd group passes over fresh evidence? How could it be? 

In its defence the Petitions Committee had originally been conscientiously pursuing this evidence. It had asked Velindre Cancer Centre for missing documentation essential to legitimise New Velindre’s cancer programme. This is still the case. 

What is this fresh evidence?

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Well, how did they select the location of New Velindre? And why plump for that particular choice of clinical underpinning for the new cancer programme? Only a few brief paragraphs are publicly available to answer these questions, and resting on an even smaller number of key lines (see extract end of this blog). But there’s a big back-story available.

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The battle for right is turning. The wire today carried news of a historic legal judgement capping the legal costs of Cat Lewis, an environmental campaigner. She attempted against all odds to stop the wrong clinical model for cancer care being also built on a very wrong choice of site. Co-locate Velindre wishes wholeheartedly to congratulate Ms Lewis on her hard-fought victory. She is now a legend and deserves to be.

This verdict emerges as an environmental legal precedent with profound implications, as Ms Lewis’s lawyers have pointed out. They write: ‘the Aarhus Convention should be broadly interpreted to provide access to environmental justice.’ https://dpglaw.co.uk/welsh-court-judgment-protects-campaigners-from-legal-costs-in-environmental-cases/

Ms Lewis herself hopes that the case will give confidence to other campaigners to challenge decisions. The battle for right is turning.

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A recruitment crisis ahead?

Our last blog welcomed the call in Senedd for a ‘workforce recruitment and retention plan for cancer specialists.’ https://colocate-velindre.co.uk/483-2/

But the Board scrutinising cancer research in Wales has pointed out a major threat to Welsh recruitment and retention. It’s the proposed New Velindre Cancer Centre itself.

Professor Neil Burnet’s letter came from the heart. He himself formerly worked at Velindre. Now he’s Chair to the Board of seven world-class professors monitoring cancer research quality throughout Wales. He reaffirmed in September his Board’s unanimous message to the Welsh research community:

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There’s a cancer workforce crisis in Wales. But most of the parties in Senedd have shown themselves switched on to the need for purpose and action. Conservative, Plaid and Liberal Democrat have demanded a Welsh 5-year Cancer Strategy. And soon.

They’ve also called for a speedy ‘workforce recruitment and retention plan for cancer specialists’. And they enjoy the support of 20 Welsh cancer charities, including Cancer Research UK in Wales. Seemingly only Welsh Labour is not switched on to this urgent need.

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