Volume 15: Government and Public Administration
4. Integrating professional advice into policy-making
Sources of external advice
Introduction
Reasons for calling on external expertise
Advisory committees

Introduction

4.56 Although government employed professional staff qualified in a range of disciplines, they could not cover every specialised issue that arose. In dealing with BSE, MAFF and DH had to address policy issues involving new or unfamiliar science, and they therefore needed specialist advice, often at short notice. They obtained this from a number of sources:

1. advisory committees;
2. individuals, including those appointed as consultant advisers to the CMO;
3. outside bodies such as professional associations or medical Royal Colleges;
4. representative bodies, such as the Joint Consultants Committee and the General Medical Services Committee;
5. networking - ie, developing a range of outside professional contacts; ¹ and
6. advice from non-departmental public bodies (NDPBs), such as the Research Councils and the Public Health Laboratory Service (PHLS). ²

4.57 This section focuses on the first of these, advisory committees of experts. Several such committees played a significant role in dealing with BSE:

1. the three set up specifically in connection with the disease - the Southwood Working Party, the Consultative Committee on Research into Spongiform Encephalopathies (known as the Tyrrell Committee, chaired by Dr David Tyrrell), and SEAC. Volumes 4 and 11 of this Report describe their role in the story;
2. those set up under section 4 of the Medicines Act 1968 to advise on applications for licences to manufacture or sell human or animal medicinal products and to promote the collection and investigation of information on adverse reactions. The role and functions of the 'section 4' committees are described in volume 7;
3. topic-specific advisory committees that were part of pre-existing networks; ³ for example on dangerous pathogens (ACDP), toxic substances (ACTS), hazards arising in the agriculture and related industries (AIAC), the control of pests (Advisory Committee on Pesticides), and the microbiological safety of food (); and
4. others - eg, the Expert Group on Animal Feedingstuffs (the Lamming Committee) and the Food Advisory Committee (FAC).

Reasons for calling on external expertise

4.58 Why did Departments seek external specialist advice? As the report of a review in 1995 of DH's arrangements for obtaining such advice noted:

. . . the principal requirement is for informed judgement to be brought to bear on all the evidence. ⁴

4.59 Both DH and MAFF employed substantial numbers of qualified specialist staff. However, DH in particular relied explicitly on external experts, for a practical reason. Sir Donald Acheson told the Inquiry that:

. . . the field over which the CMO is required to provide advice extends far beyond his own personal professional experience. It is therefore necessary for him to be supported by an extensive advisory machinery. ⁵

4.60 The need was more acute by the mid-1990s, partly because of the pressure, described in Chapter 6 of this volume, to reduce administrative costs and staff numbers:

. . . because Ministers have to answer diverse questions of ever increasing sophistication while the professional and technical capability of their Department is falling, their need for well-marshalled external advice must continue to grow. ⁶

4.61 However, drawing on external advice had other less tangible advantages. Firstly, it was accepted in Whitehall that the views of eminent and respected experts who were independent of government carried weight with, and reassured, a public increasingly sceptical of official and ministerial pronouncements. As Mr Meldrum told the Inquiry (quoting remarks he had made in 1993):

. . . there is a view from the public that they do not totally trust civil servants, of which I am one . . . the best thing you can do is to establish an expert and independent Advisory Committee who has the right to publish their views without interference from us. ⁷

4.62 Mr Geoffrey Hollis (Grade 3 Head of the Livestock Group in MAFF) expressed a similar view when asked 'Part of the object of the exercise is to gain public acceptance of the recommendations that are made?':

Yes, deliberately because they are independent, then they are not tarnished with [the] political shenanigans of government. ⁸

4.63 Related to this consideration was:

. . . the wish to secure authoritative endorsement of policy so that it will be more readily accepted, and the wish to enlist the advisers in 'ownership' of the advice so as to secure their co-operation in implementation. ⁹

4.64 Governments also recognised that decisions had to be justified, especially when they might have a negative impact on business activities and therefore on individuals' livelihoods. The key measures taken to deal with BSE - the removal of ruminant protein from the diet of cattle and of Specified Bovine Offal from the human food chain - both had significant effects on the relevant industries. Officials and Ministers were aware that decisions could be challenged in the Courts unless they were soundly based in law, were reasonable in themselves, were consistent, and had been subject to reasonable consultation. Mr John Maslin (Head of the BSE branch in MAFF's Animal Health Division) told the Inquiry that:

. . . I think every civil servant knows that whatever you do you have to be able to justify, because if you cannot justify you are subject to judicial review and things like that. Therefore, whether it is scientific or other evidence you have to have justification for things you do. I think that is something that everyone has in their mind. ¹⁰

4.65 The process of judicial review is described in Chapter 8 of this volume. Witnesses told the Inquiry that such thinking had arisen several times in connection with BSE. For example, Mr John MacGregor (former Minister of Agriculture, Fisheries and Food) considered that it had been essential to obtain external expert justification before introducing the slaughter and compensation policy. In his view:

. . . the really significant point in all of this at the end of the day was that Southwood came out in favour of a slaughter and compensation policy and that gave us the human health argument.

He added that such a policy:

. . . could have great significance for the industry and therefore I had to be sure of my ground . . . We had to have the view of those who could give us the best advice in relation to human health. If we had not taken that, then I think we would have been at risk of challenge, not just judicial review. I could have been challenged in the House of Commons or by the industry: what basis was there for thinking that this disease was so serious that you had to take that step? ¹¹

4.66 Dr David Jefferys, of the Medicines Division in DH, was involved in the discussions which led to the issue of guidelines and a questionnaire to medicines licence holders in connection with the use of bovine materials. He recalled:

It was felt that the guidelines which were eventually to be approved had to be capable of withstanding scientific scrutiny and possible legal challenge. The guidelines would have to be seen to be proportionate . . .

A further consideration during this period was that we were all waiting for a sight of the Southwood Report. This was of particular importance not simply because it was felt that it would be the most authoritative consideration of the issues raised by BSE but also because it needs to be remembered that any action taken in respect of individual pharmaceutical products had to be justified on an evidential basis. ¹²

4.67 The Inquiry was given an example of difficulties that could arise when Ministers wished to go further than external experts advised. The Southwood Working Party had considered that 'manufacturers of baby foods should avoid the use of ruminant offal and thymus'. ¹³ Ministers had concluded that Specified Bovine Offal should be removed from the human food chain generally. ¹⁴ Mrs Attridge (Head of MAFF's Animal Health Group) noted:

What we were faced with in terms of the action to be taken would be a much more regulatory approach than simply advice to manufacturers of baby food. This would be regulations which, in effect, would make people criminals if they did not obey what was in the regulation. It was a much stronger action than would have appeared to be justified if one took the Southwood Report as being the scientific base for it. That led you into a lot of potential difficulty in avoiding charges of lack of proportionality and probability of judicial review, and going further than the evidence indicated, which is always a problem in relation to action Ministers want to take unless they have the powers to take it. ¹⁵

The consideration by officials and Ministers of how this issue might be addressed is described in Chapter 3 of vol. 6: Human Health, 1989-96.

Advisory committees

4.68 To be effective, advisory committees needed clear remits, an appropriate and balanced membership, an effective chair, and proper secretariat support (normally provided by the relevant Department or Departments; joint secretariats were common, for the reasons noted below).

4.69 The general view was that such a committee's remit, even if broad, should be clearly defined so that it was aware from the start of which issues it needed to address, when advice was required, and to whom this advice was to be directed. ¹⁶ Mr Meldrum told the Inquiry that:

I do not think it is an answer to create a committee because it might be a useful thing to do. It has to be an area where you have a clear need for advice, clear objectives, clear terms of reference. ¹⁷

4.70 The membership of expert advisory committees was drawn from specialists in the relevant topics and disciplines, while the HSE occupational health advisory committees also included employer and employee representatives. However, there were occasions, particularly if the science involved was new or controversial (as with BSE), when the Government needed a broader perspective on an issue.

4.71 The choice of members therefore involved balancing the need for highly specialised knowledge against the value of experience in and across a number of disciplines. Judgement was needed as well as scientific explanation and synthesis. Mr Meldrum told the Inquiry that:

In the early days of . . . SEAC . . . we tried to get a balance between pure veterinarians, if you wish, pure medical people on the other hand and scientists who sat in the middle and were neither vets nor medics but had a particular expertise in that particular area. So far as SEAC is concerned it is quite difficult or was quite difficult to find the appropriate calibre of person who could bring to the committee the expertise one needed to make informed judgements on the issues. ¹⁸

4.72 Mr Meldrum also said, since such committees were appointed to provide government with independent advice, it would be 'most unhelpful' to fetter their recommendations or to attempt to influence their deliberations; and Sir Donald Acheson told the Inquiry that 'there should be blue water between the adviser and the advised'. ¹⁹ On the other hand, a strong and independently minded committee 'could become a "thorn in the side" of Government'. ²⁰ For this reason, as well as for the effective conduct of business, the choice of who chaired the committee was important. Individuals were selected for such posts on the basis of their perceived appreciation of what the Government was looking for, their committee skills, and their powers of persuasion, in addition to their eminence as scientists.

4.73 The work of advisory committee members often demanded a high level of commitment. Sir William Asscher (Professor of Medicine, London University) told the Inquiry that:

Although the work of the CSM [the Committee on Safety of Medicines] is purely advisory, it is very time consuming and demanding . . . As Chairman, I made sure that I read all the papers relating to each of the many items on the agenda of CSM meetings. Throughout the week I would receive bundles of CSM papers in 'blue bags' and every weekend was taken up with reading them in preparation for CSM meetings. ²¹

4.74 The workload could increase as an issue developed. Mr David Pepper (a veterinary surgeon) said that when he was invited to join SEAC, he was told that there would be a commitment to:

. . . perhaps three or four meetings a year . . . As it turned out, the commitment was a lot more than that. The amount of paperwork to read was impressive, and the number of meetings were sometimes more frequent than that and sometimes less, though as the game hotted up, of course - and as you know from your records - the number of meetings and frequencyincreased. Therefore it has been a considerably greater commitment than I originally imagined or originally envisaged for the future. ²²

4.75 The convention was that committee members were unpaid, and agreed to serve in the public interest.

4.76 Heavy workloads increased the reliance of committees on officials, especially their own secretariats. The role of the secretariat was crucial to the effective conduct of business. Its job was to ensure (a) that the committee functioned effectively (by arranging for suitable papers to be put before it and ensuring that the minutes recorded intelligibly its decisions and the reasons for them); (b) that its decisions were reported to the right people in the Department(s); and (c) that appropriate follow-up action was taken.

4.77 There was often a joint secretariat of officials from two Departments (for example, the Southwood Working Party was supported by Dr Hilary Pickles of DH and Mr Alan Lawrence of MAFF) or an administrative secretary and a 'professional' one to address the scientific aspects of the committee's work. However, the Evans Report recommended in 1995 that DH committees should have a single secretary, normally a professional, ²³ because having dual administrative and professional secretaries could lead to 'extravagant' secretarial work and note-taking. ²⁴

4.78 Normally, a committee delivered its report for consideration, and Ministers then decided which of its recommendations they wished to accept. Sometimes, however, advice was needed quickly so that early action could be taken. Because so little was known about BSE, and the CMO wanted urgent advice, the Southwood Working Party did not follow the usual model, but instead provided a series of interim recommendations. Sir Donald Acheson recalled that, by the time its final report was delivered, many of these had been or were being implemented. ²⁵

4.79 When a topic was at the cutting edge of emerging science, the 'advisers' could in effect become policy-makers. Between the autumn of 1995 and 20 March 1996, knowledge of vCJD was developing rapidly, and Ministers increasingly relied on SEAC's emerging recommendations as the main basis for their policy on BSE. ²⁶