Page last updated at 18:21 GMT, Thursday, 22 January 2009

Hart 'went against unit advice'

Two neurosurgery units will be kept running in south Wales

A controversial decision to keep two neurosurgery units open in Cardiff and Swansea went against advice of senior officials, BBC Wales has revealed.

Health Minister Edwina Hart was warned that the service should be centralised or it would be unsustainable.

Ms Hart decided both Cardiff and Swansea centres should stay open "in the best interest" of Wales with a single neurosurgical service set up.

Ms Hart defended her decision by saying that patients wanted both units.

BBC Wales Dragon's Eye programme has seen a written warning to Ms Hart from her senior medical officers from July 2008.

The warning says that without a decision to centralise neurosurgery on a single site the service would be unsustainable and leave south Wales dependent on Bristol for neurosurgery.

Edwina Hart AM
Edwina Hart has been 'scrupulous' in following the ministerial code

There have been concerns for several years that without centralising neurosurgery on a single site in south Wales, the service faced major problems.

The issue played a key part in the 2007 assembly elections.

Before becoming health minister following the election, Ms Hart attended protest rallies to keep the neurosurgery unit at Morriston Hospital, Swansea open, in her capacity as the AM for the nearby constituency of Gower.

The assembly government has since flatly denied Ms Hart has any conflict of interest and has reiterated its position that she has abided by the principles of the ministerial code at all times.

"Ministers always strictly adhere to the principles set out in the ministerial code," said a spokesman.

"Morriston Hospital is not in the minister's constituency and therefore no conflict of interest arises.

Protesters have held marches opposed to the closure of Morriston

"As health minister, Edwina Hart is responsible for the health service across Wales and makes decisions on what is in the best interest of the whole of Wales.

"The minister has always been scrupulous in referring all health matters affecting her constituency to the First Minister for decision."

The programme has also obtained the first draft of an expert independent review which clearly recommended single site option, it was then changed before publication by the authors to refer to a single service.

Ms Hart commissioned the neurosurgeon James Steers to head an independent review into neurosurgery in south Wales, following the serious concerns that the current two site arrangement at Morriston Hospital in Swansea and the University Hospital of Wales in Cardiff was unsustainable.

In the Steers review's first draft, submitted to the assembly government in July 2008, and seen by Dragon's Eye, the group say there should be an urgent development of a single neurosurgery unit for south and west Wales.

Ms Hart was not shown the draft report, but received a clear and unequivocal warning in writing from her senior medical officers, based on the report, which warned that without a decision to move to a single site in Cardiff, the neurosurgery service faced rapid collapse.

However, the second draft of the Steers report, which was subsequently published, was changed to refer to a "single neurosurgical service" for south Wales.

This enabled Ms Hart to set up a group to implement a single service option but across two sites, therefore keeping both the Swansea and Cardiff services open.

The assembly government have confirmed to BBC Wales that its officials were in contact with the review group during the period between July and August.

But they have refused to disclose whether the move to recommend a single service rather than unit was discussed, or whether the minister herself asked for any guidance to be given to the Steers review group as to their final conclusions.

Asked why she had not taken the advice of her senior medical officers, Ms Hart said: "I've gone through very complex reviews of all these issues... but I think we have to recognise that it's very important that we have two sites if we can have two sites.

"My view is that what people want is two sites, and you've got to look at what the patients want as well as to what's required, and as long as I can have services on that basis I will do it.

"At the end of the day, decisions lie with me as a politician and I was elected to take them."

Asked whether she or her officials had interfered in any way with the work of the independent Steers review into neurosurgery, Ms Hart said: "Well as the BBC went for a very lengthy FOI (freedom of information) request then you have all the relevant information."

None of the members of the Steers Review contacted by Dragon's Eye were willing to talk to the programme, referring all questions to the assembly government's press office.

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