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.
I am sorry that the original statements made in relation to the involvement of the Nuffield Trust, although made in good faith, were in fact incorrect. But I note that an apology has been given and a correction has been made.
I appreciate that you remain dissatisfied with the revised statements from the Welsh Government, but I think that this arises from a differing interpretation from that which was intended by the Welsh Government. I note that the Welsh Government has said in its correspondence with you that the proposed clinical model has been subject to independent advice from the Nuffield Trust. As far as I can see, that statement is correct.
It appears to me from your correspondence that you have taken that statement as intending to convey that the overall proposal had been endorsed by the Nuffield Trust. But I do not think that the statement bears this interpretation, and I am quite sure that it was not intended to convey that impression, but rather that the advice from the Nuffield Trust had been taken into account as part of the decision-making process. I appreciate that the exact wording used could perhaps have been better expressed to put any risk of misunderstanding beyond doubt. But I do not see that the statement in question is false, and certainly not that it was intended to deliberately mislead.
I think that a similar misunderstanding lies in your concern about the use of the term “cancer centre”. The Welsh Government in its discussions about the investment case and the decision has been focussed on a new cancer centre. The centre sits within a clinical network model, which is a broader issue and subject to multiple business cases. The case for the centre and the clinical model are two overlapping issues.
I am sorry that you have remained dissatisfied with the exchanges which you have had with the Welsh Government in relation to this issue, and I appreciate that this response will probably come as a disappointment to you as well. But, having reviewed all of the documentation carefully, I cannot see that there is a case for either the Ministerial Code or, in relation to the correspondence from officials, the Civil Service Code, having been broken. 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.
Regards,
David Richards
Cyfarwyddwr Priodoldeb a Moeseg/Director, Propriety and Ethics
Grŵp y Prif Weinidog/First Minister’s Group
Sent: 22 October 2024 16:57
To: Richards, David (FMG – Permanent Secretary’s Group – Permanent Secretary’s Group) <david.richards@gov.wales>
Subject: Re: Submission of a complaint for infringement of the ministerial code of conduct
Dear Mr Richards,
We thank you for your letter, and for recognising the incorrectness of claims of a Nuffield clinical review of New Velindre. However, your letter raises concerns about the investigation:
assumptions in play
You say: ‘the proposed clinical model was ‘subject to independent advice from the Nuffield Trust’. But you mean (unstated) only the regional cancer network model. However, the network could never have formed the topic of last year’s email exchanges because it was not a contentious issue. The Complaint focused on what was indeed controversial, as did the clinical calls for a review, which triggered the Nuffield project in the first place, i.e. the cancer centre clinical model, a decision which Nuffield was not given liberty to investigate (see below).
Moreover, both the two parties in the 2023 opening exchanges did not classify the network as the issue. Quite the opposite. Government said: ‘You have raised concerns associated with the proposed new Cancer Centre. The appropriateness of the proposed clinical model [‘for this’ implied] is something that has been raised on previous occasions and has been independently reviewed by the Nuffield Trust (27 Sep 2023). This answered an email about diminished capacity for the ‘standalone’ future cancer centre. It couldn’t be clearer, we suggest, making untrue your decision’s underlying premise.
As a result, your statement is prejudicial. Without evidence, your decision a priori declares the shared topic in the email exchanges to be the cancer network. But while the minister’s side sees it that way, the Complainants’ side does not. Hence the key assumption underlying your decision privileges one side’s viewpoint, thus invalidating the entire investigation’s impartiality.
a new construal
You introduce another rewording, though we’re not sure what it is meant to prove. Anyway, for you, the clinical model as ‘subject to independent advice from the Nuffield Trust’ now means that ‘the advice from the Nuffield Trust had been taken into account as part of the decision-making process’.We only ask whether you really believe this awkward, convoluted rendering could actually become read as signifying a Nuffield review by honest mistake!
a further contradiction
But now the question arises of why the minister did not, on your account of things, just come out with your new, supposed underlying explanation in her email 8th Nov 2023 introducing the phrase ‘subject to Nuffield’. She seems to see ‘subject to Nuffield’ in the sense we have taken from it. That sense is that Nuffield approved (or, we might say, ‘endorsed’) the [network] model as ‘a reasonable way forward’. No hint of a later decision-making process here.
So, in short you and the minister conflict. But why did the minister not opt here for your rewording, since on your account it must be her perspective too? She could have dispelled every ‘misunderstanding’ and dismissed the debate, as you believe you have now done. The most obvious explanation, we suggest, would be this: your rather late rendering did not exist then in her mind or in anyone else’s, or it would have been deployed in the email exchanges.
Granted, the minister nevertheless accepts your new construal. But this only highlights one more contradiction from her, arguably prompted by a concerted effort to clear government ministers of complicity in the long-embedded erroneous claim of a Nuffield clinical review.
The impression forced on us, therefore, is that you are basing your verdict about our claim precariously upon yet another on-the-hoof adaptation. It looks like an attempt at offloading accountability for the false Nuffield review narrative without tipping into self-contradiction. But this attempt, we suggest, has failed. Each new drifting and reinterpretation only reveals a further dislocation from previous expressions, especially that of a ‘Nuffield review’.
Claims that a Nuffield clinical review validated the cancer centre model began at the Health Committee, Sept 2020, and also 19th March 2021 both from the then health minister. To imply these were slips ‘made in good faith’, surely stretches credulity beyond human endurance.
We don’t recognise our supposed concerns about the term “cancer centre”’ or our mentioning any ‘overall proposal’. But we do see a red flag in your note that ‘the ‘case for the centre and the clinical model are two overlapping issues.’ This could be forced to mean that Nuffield’s approvals of the cancer network also retrospectively approved the cancer centre standalone choice. But this could not have been. Nuffield focused strictly on the risks and benefits for network management, including those ‘posed’ by a standalone model. This exposes that the cancer centre’s choice of model was protected and allowed no such retrospective inspection.
Meantime the spending spree on a new Velindre, out of date before built, is a sinkhole for precious cancer money. The project enjoys a free pass instead of the customary external, clinical review exercise, since Nuffield did not provide that. The Advice did, however, predict that a stand-alone Velindre’s work would diminish because of changing cancer treatments.
further imbalance in this decision
You say only that you discussed the issues with the policy team from the health department. This, we suggest, is a unbalanced and limited range of witnesses. The health policy team was involved in producing the emails of the then health minister. That team is a participant not an impartial witness. You and PET, therefore, have illustrated why expert advice recently given to PAPAC at Senedd strongly favoured the exclusion of policy advisors from overseeing or conducting investigations. The only way out for PET now is to refer our Complaint to an external independent investigator unconnected to the party.
You close with the promise that you ‘will not be taking any further action in relation to this correspondence.’ This is a pity, as so much remains in need of clearing up. As for us, we cannot detect cancer care justice for patients at the forefront and centre of this project, and therefore do not have the option of taking no further action and giving up on publicising truth.
Yours sincerely,
Penny Owen (Dr)
Roy Kearsley (Dr [not medical])
On behalf of Colocate Velindre
From:david.richards@gov.wales
Wed, 23 Oct at 15:54
Dear Dr Owen and Dr Kearsley.
Thank you for your response below to my earlier message, which I have read carefully.
I am sorry that we are not able to agree on this matter, but I do not think that there is anything to be gained by continuing the correspondence further. However, we will certainly keep your reply on our records.
Yours sincerely,
David Richards
