Independence is crucial to a successful review, but how well is the idea of “independence” actually understood? Independence is about many things - much more than the money and relationships. It is vital to ensure that there are systems, processes, and controls, all of which act to protect the judgements made; just as important are honesty, integrity, and accountability in professional practice.
Here we explain what we mean by independence, why it matters, and how to improve it – both as projects are delivered, and more widely.
What do we mean by independence?
“Independence” is not a yes/no consideration; it is simplistic and inaccurate ever to describe someone or their work as either “completely” independent, or as “not at all” independent. Independence occurs along a continuum and can be both actual and perceived.
Actual independence is made up of a multitude of ‘checks and balances’ which must be applied continuously throughout the process of independent review; this is all part of good professional practice. Perceived independence, whilst important, is often used to support an individual’s assessment of the review outcome: ‘it was an independent view if it agreed with my point of view, it was not independent if it didn’t’.
Why does independence matter?
Independence promotes confidence. In matters where judgements are being made, particularly when using public money for review work, it is entirely appropriate to query – and to seek – the independence of those undertaking that work. Particularly, to want confirmation that there is probity and that independent reviewers can exercise judgement without fear or favour. That means two things:
What are the limits of independence?
An independent review requires the provision of a highly skilled service, and that service should be remunerated, whether a public, charitable, or private sector body is undertaking the work. Direct payment from the ‘receiver’ to the ‘reviewer’ for an ‘independent’ opinion, is of course, never easy to fully reconcile. The stamp of independence is valuable and there are no doubt cases where a favourable veneer has been either purchased or offered as an
inducement.
And yet we know from our day-to-day lives – if we seek professional advice on our finances, health, or legal matters, we usually pay for an independent, professional opinion. Despite our paying for that opinion, we still have a right to expect the advice to be based on the professional’s best judgement, not simply on what we want to hear. This is why demonstrating and upholding independence by using strict professional and accountable practices, is of paramount importance.
When ‘lack of independence’ is suggested in order to discredit a review, this may be because of the funding flow or conflicts of interest. Looking at both of those:
1. Direct payment funding flow for an independent view
Any funding could be seen as an inducement for an opinion. but it doesn’t follow that zero funding is a more secure alternative. A charity requires revenues to function, particularly if delivering a commissioned service. A charity or company working on a pro bono basis is still engaged in a transaction. Indeed, the point of pro bono work may be to incentivise the client to buy more.
A public sector body reviewing itself might resolve the problematic issue of funding but might introduce another range of inducements such as contract awards, promotions, and, where the NHS is concerned, a considerable amount of organisational politics. Fully impartial insight is difficult if someone is commenting on their own performance or that of their colleagues.
2. Individual conflicts
Individual conflicts must also be managed. This is not only about where someone has worked in the past, but also about their close personal and professional relationships and any opinions they may have stated in the past. The Grenfell Tower Enquiry ended work with both a key expert panel member and the nominated accountancy firm having to stand down, because of conflicts arising from other business and audit relationships. In 2014 Lady Butler-Schloss was also forced to stand down from her role on the Child Abuse Enquiry because of the legacy of the actions of her brother in which a conflict was perceived. Such conflicts, if identified at a late stage, can have the power to completely undermine the integrity of a review.
However, it is still important that an independent review has access to subject matter experts who have a working knowledge of practice. It is key, therefore, to apply strict controls when making independent review panel appointments. In some cases, the expert opinion required can be so super-specialist (only 4 experts in the country, for example) that it is impossible to avoid professional networks. It is in the few cases like this that conflicts must be managed, rather than avoided.
How to improve independence – as projects are delivered
When people seek independence, what they want is a fair and balanced professional judgement, based on reliable evidence, and rational analysis. This requires full attention to all of the following:
Minimising bias and subjectivity: The following are all threats to independence:
Recognising and challenging bias amongst reviewers is crucial and this is done through training, awareness and challenge. It is just as important for independent reviewers to be able to recognise bias in others, for example in discrimination, or in unconscious bias which has impacted patient safety.
How to improve independence – overall approaches
In addition to proper professional practice in delivery there are overall actions which support
independence:
In considering how best to structure the commissioning of reviews, dismissing all management consultants as being ‘the problem’ is unhelpful. Previous alternatives such as the Audit Commission were themselves expensive3 to the public purse and were also not subject to competitive pressure (which is both a cost and a quality improvement incentive). The notion that there should be a single state provider of reviews of state activities is very hard to justify in a liberal democracy, today that might include the CQC or HSIB. Skilled management consultants, many of whom have direct experience of working within similar services to those being reviewed, provide expertise as well as choice in the market and this competitiveness, particularly when using frameworks, should drive costs down. Independent and skilled firms, who are able to work at scale, should also reduce the need for expensive, lengthy, public inquiries.
Not all firms providing advice should be FCA or Law Society regulated, but there is benefit to having a professional services ‘umbrella’. Smaller and boutique advisory firms would be helped by demonstrating that they meet certain standards (for non-framework commissions); as it stands, they tend to seek out a range of separate certifications which clients aren’t always familiar with (apart from perhaps ISO certifications of quality or information governance). Some form of accreditation of investigation and review practice would be a
good step.
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