Over-rule on the cards on health?
Could the Welsh Government be planning to intervene in the bitter - and escalating - row over neonatal intensive care in North Wales?
There are increasing signs that ministers are spooked by the sheer scale of the row over the Betsi Cadwaladr UHB plans to transfer new babies needing the highest level of treatment out of North Wales and to the Arrowe Park hospital on the Wirral.
The health board is facing a concerted cross party campaign to reverse its decision. Protesters were dismayed last week when patient watchdog the Community Health Council decided not to use its powers to refer the move to the Health Minister to make the final decision and potentially over-rule the UHB. Many now feel it's a done deal.
But are they right? Perhaps not.
There is certainly significant anger about the CHC decision not to refer the neonatal plans. Several senior politicians in the region have questioned the point of having a patients watchdog at all if it fails to reflect the local strength of feeling on such issues. Remember the CHC is the sole organisation which has the power to refer change plans to ministers. But it may not be the "last shot in the locker" as some fear; remember the Welsh NHS is a wholly-owned subsidiary of the Welsh Government and the Health Minister ultimately calls the shots.
The pressure on her is now intense. Labour councillors locally are bitterly opposed to the decision. The Labour AM for the Vale of Clwyd, Ann Jones has signed a letter of protest alongside AMs from the three other parties - a rare event indeed. The issue has been discussed at Cabinet level.
Ministers are uneasy about the move on several fronts, some related to the degree of opposition within their own party, others to the strength of local feeling, including the Daily Post campaign, and the precedent of actively moving the service out of the Welsh health system and into the English one.
Until now, the Welsh Government has always said it cannot say anything on any health proposals because of the quasi-judicial role that ministers potentially have, if plans are referred to them for decision. Just that has happened in the case of many of those put forward by the Hywel Dda LHB.
But at health questions this afternoon, Lesley Griffiths went far further than she ever has before in discussing the plans in public. While emphasising the need for "due process", she acknowledged the volume of correspondence opposing the move, much from people whose opinion "she greatly respects". Crucially, she confirmed that she reserved the right to call in the decision herself. Sources suggest the minister, under pressure, is coming round to this approach.
Speaking at First Minister's Questions yesterday, First Minister Carwyn Jones said, "Should we be over-reliant in the future, and this is a general point on a health service in England that is being wrecked and privatised? I think that is a fair point and one which will need to be considered in its entirety when we consider the future of the health service in Wales as a whole".
There in a nutshell, is the Welsh Government's dilemma. Mr Jones spends a considerable amount of time suggesting that the English NHS will go to hell in a handcart in the coming years as a result of the UK Government's reforms. If he really thinks that, why then, ask opponents of the change, is he comfortable to export the sickest and most vulnerable newborns in North Wales directly into that system? There's no easy answer to that.
One possibility is that the Health Minister will allow the board to transfer services to England - but place a time restriction of perhaps two years on it, while in the meantime ordering Betsi Cadwaladr to build up an indigenous service in Wales. The main problem currently is said to be throughput - that is, there aren't enough babies requiring the high level of care in the region to make the service sustainable. A new system would need to overcome this and of course, find some extra money.
A decision by Lesley Griffiths to over-rule Betsi Cadwaladr UHB on the neo-natal issue would be strongly welcomed by those who have been campaigning against the transfer to the Wirral. But the precedent, particularly if it is done pro-actively by the Minister, rather than resulting from a CHC referral, isn't great for the Welsh Government to put it mildly.
First of all, it hangs the health board out to dry. They've said publicly on numerous occasions that there is no safe and sustainable solution for this kind of care able to be provided in North Wales. The Welsh Government would presumably have to find an answer that has so far eluded the BCUHB chief executive Mary Burrows and her colleagues, who have taken immense flak on the Arrowe Park proposal for months.
But such an overrule would have national implications, with equally unpopular reconfiguration proposals already finalised in West Wales and soon to be published for a number of health boards across South Wales.
What does it say to those boards gearing up for a bare-knuckle fight with local protesters if this controversial decision by Betsi is reversed by the Health Minister, however great the pressure on her?
You'll note the question mark in the headline - nothing is clear but keep watching this space.