Image caption The Case For Change report said some NHS services were in danger of "collapse"

Doctors' leaders have heaped more pressure on the health minister, saying a controversial report into NHS reforms in Wales is now discredited.

The British Medical Association (BMA) says the report can no longer be seen as independent after emails emerged between its author and civil servants.

But NHS medical directors backed the report, saying it proves services need urgent reform.

Health Minister Lesley Griffiths denies any government influence on the report.

Its author, health economist Professor Marcus Longley, said The Case for Change which was commissioned by the NHS Confederation and published in May, was compiled "without bias or influence."

But a political row broke out when an email thread emerged following a Freedom of Information request.

It shows the Prof Longley contacted senior Welsh government officials while he was writing the report and asked civil servants for "killer facts" to support the case for changes.

He emailed the NHS Wales medical director Dr Chris Jones - also a senior Welsh government civil servant - asking for further evidence "to sharpen up the document and its impact in supporting the case for change".

In another email, Dr Jones asks Prof Longley to make his report "more positive if possible i.e describing a persuasive vision of how things could be better".

Mrs Griffiths said she did not see the report until it was in its final form and said her officials did not influence it.

In the report , Prof Longley warned that some services were in danger of "collapse".

Analysis I think we're a bit clearer about a few things, including that the opposition parties are working together on this. They sense that they have found evidence with these e-mails they're not happy with, and they're not happy with what they heard on Tuesday from the First Minister or the health minister. They went on the attack, but the feel they were dismissed and answers weren't given. They want to push on but the questions are how far do they push on and what do they feel they are able to do? Within the medical profession, you have the BMA saying the report has been discredited as independent and the public would feel manipulated into accepting the case for change. But clinical directors on the other hand have every faith in its independence and say it reflects the NHS today and the way the report sets out case for change is compelling and accurate. The opposition are asking what was the report for, what were the terms of reference? Was Marcus Longley asked to make the case for change or was he asked to sift through the case for evidence and come to his own conclusions about the need for change? I sense the opposition parties are going to do everything they can, not to let this one go. It's not that they're sensing blood but I think they are sensing here that there is something that hasn't been unravelled and they want to try and do that before the end of term.

Ministers had hailed the document as evidence to support the case for potentially controversial changes to hospitals.

Now the BMA is questioning whether the report was published to justify hospital changes.

Dr Richard Lewis, Welsh secretary of the BMA, said in light of the emails "there is no way that this report can continue to be hailed as an independent piece of academic research".

"We thought at the time that the report was published, that the evidence set out in the technical documents was insufficient to support the bold statements contained in the summary document.

"We must now question whether this report was published in an attempt to justify plans for service change which were being designed by health boards.

"These revelations call into question the commitment to provide the public in Wales with world class health services.

"Rather, it could be viewed as a cynical attempt to downgrade quality and access to services by manipulating the opinions of health professionals and the public through a now discredited report."

But in a joint statement, the medical directors of the local health boards said they fully supported Prof Longley's findings.

'Urgent action'

"As senior doctors, we recognise the evidence it contains, and are confident that it is a true and accurate account of the issues facing the NHS in Wales," they said.

"We work with these very serious challenges on a daily basis and it is vital that the report's key messages are not ignored, and that urgent action is taken.

"The NHS in Wales urgently needs reform, otherwise services will collapse and patients will suffer. This report offers the platform to launch those reforms.

"The NHS in Wales is too important to be a political football. We all need to work together to develop a safer, more effective and sustainable NHS in Wales for the future."

Mrs Griffiths, responding to calls from the Conservatives to resign, said she was not directly involved in the "formation of the report".

She also said the process around the preparation of the report was "irreproachable".

In an urgent statement to the assembly on Tuesday following a furious reaction from opposition parties, she said: "I simply cannot allow political posturing to block the path of good government being done.

"Be under no illusions, good government means taking the tough decisions on the NHS that enables it to be safe and sustainable in the future."

Media playback is unsupported on your device Media caption Labour AM Mark Drakeford, health committee chair, said the row was a "distraction"

She said the emails showed they were simply responding to Prof Longley's requests for data or advice on presenting the report.

Welsh Liberal Democrat leader Kirsty Williams told BBC Wales: "We need an open and transparent and honest debate with the people of Wales about the state of the NHS and we need to have that debate in an atmosphere of trust - and that just got a whole lot harder."

Conservative AM William Graham, a member of the assembly's health and social care committee, wants Mrs Griffiths to explain the process in more detail.

"The first minister has already said the health minister would be available to come to the committee to answer questions - let's do that," he told BBC Radio Wales.

"Let's see what really lies behind it, how the report was commissioned, how it came about, why there were these emails and then get a full understanding of what's actually happening."

Prof Longley is a highly respected health economist and director of the Welsh Institute for Health and Social Care at the University of Glamorgan.

He has defended his report, saying: "The Case for Change document is an entirely independent piece of work carried out by myself in partnership with NHS Confederation Wales.

"The Welsh government is by definition the sole custodian of much of the data required in compiling this report, and any correspondence with them was to source this information.

"The report makes a strong and valid case for change in the way our NHS operates and was compiled without bias or influence."

Local health boards will soon publish proposals intended to put the NHS on a long-term footing, but they could mean some people having to travel further for some services.

Chief medical officer for Wales Dr Tony Jewell said Prof Longley was a "well respected academic" and he was not surprised he was in contact with government officials in the course of his work.

"Nothing in Marcus Longley's report surprised people," he told BBC Good Morning Wales.

"We want a world class NHS in Wales and to do that we need to modernise the service.

"Yesterday all the medical directors in every NHS across Wales wrote in and said they are in agreement with the findings of the Longley report."