Publication - Publication

An Investigative Review into the process of establishing, managing and supporting Independent Reviews in Scotland

Published: 26 Oct 2018
Part of:
Health and social care
ISBN:
9781787813342

An Investigative Review into the process of establishing, managing and supporting Independent Reviews in Scotland, with particular reference to the Independent Review of Transvaginal Mesh.

137 page PDF

1.0 MB

137 page PDF

1.0 MB

Contents
An Investigative Review into the process of establishing, managing and supporting Independent Reviews in Scotland
Chapter 9: The timeframe, administration and budget of a review

137 page PDF

1.0 MB

Chapter 9: The timeframe, administration and budget of a review

291. Well-drafted terms of reference should set out the proposed timescale for the investigation.[124] The timescale should have regard to the nature and scale of the proposed work to be undertaken. Other factors including administrative support and the availability of the chair and other members of the review will influence the time that the review will require. There is no collated data available in Scotland on timescales for commissioned investigations generally but some post 2000 examples of non- statutory investigations include the following:

  • Report of the Scottish Prisons Commission was commissioned in September 2007 and reported in July 2008.[125]
  • Independent Review of Transvaginal Mesh Implants was commissioned in June 2014 and reported March 2017.[126]
  • National Cremation Investigation was commissioned in June 2014 and reported July 2016.[127]
  • Use of Biometric Data and Technologies was commissioned in June 2017 and reported in March 2018.[128]

292. The Institute for Government (UK) conducted a comparison on different types of formal independent investigation and noted,that of the 60 inquiries that have completed since 1990-2017, non-statutory inquiries took between one to seven years with a median length of one and a half years.[129]

The Mesh Review

Was there a process in place to agree the timeframe?

293. There was an expectation, although not minuted, that the Mesh Review would have a duration of somewhere between six to 12 months. Two members said they were explicitly told it was around a six month commitment; others appear to have assumed this to be the case. This seemed to be very optimistic.

294. A Scottish Government official told us that the first chair was advised that the duration of the Review would be about six months. Based on her previous experience, she believed that it was more likely to be nearer a year. One member criticised the lack of a clear timeline for the report. They contrasted this with other review groups they have participated in, commenting that in other groups:

“we had a timeline right from the beginning. The topic was smaller so it was different. We had an external person reporting. There was a presentation defined in one meeting and then we had another possible two or three face to face meetings and everything else was done by email and agreement of paper reports.”

295. Some members drew this to the Group’s attention because they were concerned that the length of time would affect the credibility of the Report. There was a sense of weariness, “the whole thing was dragging on for a very long time.”

296. No formal indication was given in relation to the duration of the Review. There was an assumption that it would last approximately six months to one year. The duration of the Mesh Review from its inception to the publication of the Final report was two years and nine months.[130] This was a clear underestimation of the time commitment it ultimately required.

We recommend that there should be a clear and realistic indication of the timeline of a review. This should be included in the terms of reference.

We recommend that the commissioning party should provide oversight and support to the chair to manage and review any lapse in timescale .

Administration

297. A few members mentioned having issues with administrative support they were receiving with regard to literature for meetings. A few participants noted not being given enough time to digest the content before meetings; this was seen as especially so for lay members of the group.

“different people assimilate information at different rates, and I know there has been concern from the Patient Groups that there was not enough time to assess information.”

298. Members had mixed views with regard to their assessment of the secretariat support they were provided. A common theme was that the secretariat appeared to be “overstretched” and under pressure. They stated that the Review did not have a dedicated administrative team therefore the secretariat had to provide support whilst also completing “their day job”. The impression provided was that this was the underlying reason for the difficulties encountered by most members, rather than there being any competence issue with the individuals involved.

299. One member felt that the provision of administrative support became more fragmented in the latter stage of the Mesh Review. A Scottish Government official conceded this point, acknowledging that the administrators were so short of time that, in the later meetings following the publication of the Interim Report, the administrator tried to write a “note of the meeting rather than a minute.”

“I mean completely I think poorly supported, too much expected of [them] and I did actually write to commend [them] and say thank you for the things that [they] had done because he really did try to be helpful.”

300. The first chair believed that the nature of the subject matter should have triggered more support than simply relying on the work of just one person.

301. Administrative support was underfunded. It should have been anticipated that the subject matter of the Review and numbers of the membership of the Mesh Review was always going to require a substantial amount of secretarial support. Apart from the roles that one would expect of a secretariat; preparing the agenda and related papers, arranging accommodation, transport etc., as the Review progressed, the secretariat had additional, challenging duties having to manage an increasing public, political and media interest. Secretarial support was also one of a number of duties that the secretariat undertook in addition to other substantive roles within the Scottish Government.

302. Consideration should be given to the merits of having a dedicated administrative support unit whose responsibility would be to provide administrative support for all reviews commissioned. This would bring with it knowledge, experience and consistency of approach. However, we recognise that this would have resource implications and may lack the flexibility or distinctiveness of approach that would more naturally occur from having a different administration in place for each review.

We recommend that consideration should be given to the creation of a dedicated administrative support unit within the Scottish Government. This unit could be utilised for all commissioned reviews.

IT facilities

303. A number of participants had issues with the video/teleconferencing facilities and alluded to them increasing the difficulty of contributing to meetings if not in physical attendance. “[It] makes a difference … body language … making sure everybody has their say.” One member described it as “isolating” and that it was hard to hear, making it difficult to resolve points of contention.

304. This represented an acute problem for both of the chairs and was not conducive to ensuring that the large group involved had the opportunity to be heard. Government officials were aware that the quality of IT facilities was not ideal but it was not within the scope of their resources to be able to address this.

Minutes

305. Meeting minutes are the written or recorded documentation used to inform what was discussed and what happened during a meeting. They document the key ideas or discussion points that led to a decision.[131] They record actions to be taken. They should be understood without reference to other documents.[132] They are important because they provide a written record of what was discussed and agreed.[133] The extent and nature of what is recorded should be agreed with the Chair at the outset of any review.[134] This should also be made clear to the review’s members. Minutes should be circulated as promptly as possible after the meeting. It is suggested that this should be no later than one week from the date of the meeting.[135] This allows the minute taker and the recipient to still have a reasonable recollection of what occurred in the meeting and be satisfied that the minutes record an accurate account. The conclusions of a minute should be clear and precise. If this is not the case, then it could lead to questions and differences of interpretation regarding what was discussed.

The Mesh Review

306. We received comments on the consistency and quality of the minutes. There were clear omissions of relevant matters which should have been recorded in the minutes. These included, for example;

  • the resignation of the first chair and why she resigned;
  • introduction and background of the second chair;
  • petitioners’ concerns over the content and structure of the Final Report;
  • resignation of the petitioners’ and why they resigned;
  • resignation of Dr Agur and why he resigned.

307. It was difficult to keep track of who was attending meetings and what their role was. For example, Julia Wilkens and Anne Conacher are both listed as attendees at the first meeting[136] and June McAdam at the second meeting[137] but do not appear on the Interim or Final Reports in the list of members. An explanation of why they did not attend other meetings is not minuted. Professor Catheryn Glazener intimated that she was stepping down from the Group in a meeting of March 2016 yet her apologies were noted for the subsequent two meetings.[138]

308. Many of the members said that agreement appeared to be reached during the meetings only for follow-up emails to be sent indicating that this was not the case. The second agenda item for meeting seven[139] notes that agreement on the minutes of meetings four and five have still not been reached. There is no indication in subsequent minutes whether this was ever resolved. A member stated they “often” received minutes from meetings which had been held six months earlier.

309. Clinician members met as a sub-group in October 2016. They met again in January 2017 and also spoke via teleconference. The second chair of the review also held teleconferences with the petitioners’ and separately with Isobel Montgomery in January 2017. None of these discussions were minuted.

310. A change of style was noted towards the final meetings when there was a change of the person taking minutes. This resulted in the minutes being very brief and more of a note than a minute.

311. Members of the Review appeared to disagree on what format or style the minutes should adopt. Similarly, there was a lack of understanding as to the purpose of the minutes. The substantive content should only have been challenged if it was wrong, not if there was merely a difference in opinion on its interpretation. Minutes should have been circulated for approval as soon as possible after each meeting. Failures to reach agreement on key matters should have been minuted and their resolution noted.

We recommend that the ultimate responsibility for the content of the minutes rests with the chair.

Processes adopted for archiving materials

312. Archiving is the process of moving materials that are no longer actively used to a separate storage device for retention. They provide evidence as a source of research, historical and public interest[140]. Files and parts of files should be easily located and retrieved.[141] The Scottish Government usually creates a website for each review which will contain files and materials relevant to the review. The style and format of these varies from review to review.

313. It was useful to contrast the Review’s webpages with two other investigations that, whilst different in scope, offered models and templates on how this information could be better organised and hosted; namely, the Infant Cremation Commission[142] and the Motorsport Event Safety Review.[143] Both of these are hosted on the Scottish Government website.

314. The Infant Cremation Commission (ICC), chaired by Lord Bonomy, also dealt with an extremely controversial and emotive issue that affected large numbers of people in Scotland.

315. The ICC’s webpages are well-organised. Of note is the ICC’s relationship to other, related areas of the Scottish Government website, including, the policy and legislative processes. These are clearly signposted via the left-hand menu on the ICC’s webpage, whilst associated weblinks and documentation are accessible via the right- hand menu. The ICC’s remit is also included on the opening webpage, which gives context and background to the associated material. The letter written by Lord Bonomy to Michael Matheson (then Minister for Public Health) upon completion of the ICC’s Report also acts as a precis to the Report itself.

316. Other differences between the ICC and the Mesh Review include:

  • Minutes of meetings are included on the ICC webpages, but Agendas are not;
  • Email exchanges are not included on the ICC webpages;
  • Declarations of Interest are not included on the ICC webpages;
  • The link between the National Committee on Infant Cremation (a legacy group to the ICC) and the ICC are clear, and published papers relating to the National Committee on Infant Cremation are held separately.

317. The ICC’s webpages provide more context and background, are better organised, are more streamlined (in that less information is presented, but what is presented is relevant and, crucially, the rationale for its inclusion is clear), and are more easily navigable.

318. The Motorsport Event Safety Review’s webpages similarly, are well organised yet are more in keeping with the Mesh Review’s webpages than the ICC’s (most likely because there is no association with the policy and legislative process).[144] The Motorsport Event Safety Review’s pages provide more context and background, are better organised, more streamlined, and more easily navigable.

319. Other differences between the Motorsport Event Safety Review and the Mesh Review include:

  • Minutes of meetings are included on the Motorsport Event Safety Review webpages, but Agendas are not;
  • Email exchanges are not included on the Motorsport Event Safety Review webpages;
  • Declarations of Interest are not included on the Motorsport Event Safety Review webpages;
  • Tabled papers are included on the Motorsport Event Safety Review webpages.

The Mesh Review

320. Compared to other Commissions, Inquiries, Reviews and Panels, the Mesh Review provided a surfeit of information in downloadable documents, including Agendas, Minutes of meetings and related documentation. This included email exchanges, Declarations of Members’ interests, alternative versions of chapters, and documentation relating to other Reviews of mesh and tapes. However, the provision of the material was unstructured and sporadic and the criteria for inclusion on the Review’s webpages were not clear.

321. There were issues and disagreements in regard to which related documentation and information should be provided on the Review’s website and this often led to delays.

322. Processes adopted for archiving materials hosted on the Scottish Government website need to be consistent. They should enhance public awareness and understanding of the process by which any reports, outputs or recommendations were produced. It should also be clear why documentation is included, and its relevance. Well-organised and complete documentation would also potentially reduce the number of Freedom of Information requests.

323. These were things that were not done but should include;

  • Minutes of meetings to be included but agendas not;
  • If Agendas and Minutes are included, these should be stored together on a meeting-by-meeting basis;
  • email exchanges are not included;
  • The context and background to any Commissions/Inquiries/Reviews/Panels should be included;
  • A precis of any report should be included;
  • A file type should be agreed for downloadable documents.

We recommend that there should be a template that standardises what is presented at the conclusion of a Review, and how this information is presented.

Budget

324. Statutory inquiries have a range of provisions under the 2005 Act which include meeting the expenses of witnesses,[145] and discretionary powers for the commissioning Minister and the chair to control the costs. No similar regulations apply to a non- statutory inquiry. Despite this, there is no clear distinction between the costs for a statutory inquiry and a non-statutory inquiry.[146] Both types are funded by the government and accountable to Parliament for their expenditure. The amounts that are spent on investigations are significant. The National Audit Office recently produced a Report which notes that the UK government has spent more than £200 million on 26 inquiries that have been established and reported since 2005.[147]

325.. In any review, in addition to having a clear understanding of matters such as remit and timescale, it seems only sensible for there to be early and precise discussions as to what type of budget is being set for the completion of the review.

The Mesh Review

326. There was no agreed budget for the Mesh Review.

327. The first chair of the Mesh Review said that she enquired as to the arrangements for the budget for the review but was simply told that there was no budget: “I did say isn’t there a budget and I was informed there is no budget.”

328. One of the members believed there were “sticking points” happening in relation to resourcing. They described making suggestions on retrospective work that could have been done to collect qualitative evidence from those who had good surgical outcomes; but that the request was rejected. Another said “it was very much underfunded” suggesting that the budget could have been used to provide bespoke administrative support. Other members commented on the lack of funding noting that “it was inadequate and/or wrongly zoned.”

329. Neither the chairs nor the members received any remuneration for undertaking the work of the Review. No discussion took place as to what resources were available for the Mesh Review, how these were to be allocated and how they could be accessed.

330. The fact that there had been no discussion at the outset of the Mesh Review around important issues such as resources and budget was a major omission which cannot be overstated. Budget and resourcing are an integral matter for any review and should have been discussed by the commissioning party, in this case, the Government Minister, and the Chair. Before a chair or members agree to become members of a review, they should be aware of what arrangements are being made to properly resource the review. The budget should also inform and identify the priorities and work of the review. A failure in this regard carries a number of risks; not least that the review will not be able to achieve its purpose. Perhaps, just as importantly, it risks attracting the criticism that the commissioning party is simply setting up a review or task force to avoid claims of inactivity on a subject matter without any real interest in ensuring the success of the project.

We recommend that a budget should be identified at the beginning of any discussion on the commission of a review.

We recommend that the chair and members should be advised if there is to be remuneration for membership and, if so, agreement should be reached on the terms of any remuneration.


Contact

Email: David Bishop