Volume 15: Government and Public Administration
4. Integrating professional advice into policy-making
Relationships between professional and administrative staff in MAFF and DH
Introduction
Ministry of Agriculture, Fisheries and Food (MAFF)
Department of Health (DH)

Introduction

4.28 MAFF and DH employed large numbers of professional staff. During the period covered by the Inquiry, both Departments reviewed the question of how best to deploy such staff and tried different ways of doing so. Briefly, in MAFF the Headquarters Group of the SVS was merged with the Animal Health (including meat hygiene) administrators in 1990, creating an Animal Health and Veterinary Group (AHVG) headed by the CVO. In 1994, this merger was reversed. The long-standing approach in DH was to have parallel administrative and medical hierarchies reporting to the Permanent Secretary and the CMO respectively. By 1994, there were paired medical and administrative divisions supervised by Divisional Management Boards led jointly by administrative and medical Grade 3s. A year later, the parallel structure was replaced by fully integrated divisions comprising both administrative and medical staff.

4.29 These developments and the structures associated with them are described more fully in Annex 1 on the organisation of MAFF and DH.

4.30 A number of witnesses told the Inquiry how professional and administrative staff worked together before, during and after these changes. The evidence suggests that in general the relationship was harmonious, but that there were tensions, professional and organisational.

Ministry of Agriculture, Fisheries and Food (MAFF)

4.31 A former MAFF Permanent Secretary, Sir Derek Andrews, described how:

. . . this [Animal Health] was an area of the Department where people had been working in parallel . . . in cooperation for a very long time - I think people knew . . . the ground rules for the input into policy that the vets and the scientists had as against the input that the administrators had. And in a sense there was not any individual within that organisation that had an overall policy lead. It would be a matter of discussion between them and the policy submissions that came up from that part of the Department would be prepared cooperatively between the vets, the scientists . . . and the administrators. ¹

4.32 The lead on a particular policy matter would depend on the type of issue being considered. Issues of veterinary science naturally fell to the veterinarians. But where wider considerations were involved (for example, the effects of a proposal on business, or relationships with other European Member States), administrators took the lead. ² Mr Cruickshank (Head of MAFF's Animal Health Group of administrators) told the Inquiry that:

. . . policy papers to Ministers were normally submitted by administrative staff (in particular, the Under Secretary, Animal Health), whereas papers dealing with purely veterinary matters could be sent forward by the Chief Veterinary Officer. All policy papers were however drafted in the closest consultation with veterinary colleagues and agreed with them. ³

4.33 Animal Health administrators sought to maintain a distinction between themselves and their professional colleagues:

I always regarded the arrangements as being a convention whereby we worked very closely with veterinarians, but there was, if you like, a dividing line where, you know, if we wanted veterinary advice then we would ask our veterinary colleagues. And I think it worked pretty well. ⁴

I think it is important to remember that we were not paid to be veterinarians. It is very important for us not to try to be veterinarians . . . because we were not. ⁵

Veterinary scientific advice to Ministers could clearly only come from the State Veterinary Service. Most policy issues however involved not only veterinary but also legal, financial, economic and other considerations. It was the task of the administrative staff to ensure that these considerations were taken into account in the development and implementation of policy. ⁶

4.34 However, administrators did not unquestioningly defer to veterinarians' advice. As Mr Cruickshank explained when giving oral evidence, if the reasoning was not clear, they would seek further background. ⁷ They were aware of the need for policy, on issues of any kind, to be soundly based and reasonable (a point discussed in paragraphs 4.64-4.67 and, more fully, in Chapter 8).

4.35 Mr Cruickshank told the Inquiry that 'the system worked quite well in relation to policy development' but that 'it worked much less well in relation to monitoring of progress on the ground, operations and management'. Hence the idea of integrated units:

. . . for each subject there would be a group of people with the appropriate expertise for that subject . . . and each of these teams would have a . . . single budget. This would integrate policy development and management of operations on the ground. ⁸

4.36 The CVO at the time, Mr Meldrum, told the Inquiry that this initiative was suggested by Mr Cruickshank 'in an attempt to streamline the Tolworth structure to reduce the need for such widespread internal consultation on policy issues'. ⁹ Mrs Elizabeth Attridge, Mr Cruickshank's successor, believed that in the merged AHVG which was established in due course:

. . . the financial lines were clarified in that the animal health work was brought within the financial framework of the Food Safety Directorate, not being part of ADAS . . . It brought the veterinarians much closer to the administrative part of the complex in that they were now both directly reporting to the one Grade 2. ¹⁰

However, Mr Kevin Taylor told the Inquiry that:

The process was never completed . . . the Animal Health and Welfare Veterinary Section continued to operate . . . as a separate team of veterinary surgeons advising administrative Divisions. ¹¹

4.37 This unified approach was to all intents and purposes reversed in 1994. The Lebrecht Report, a review of the merged AHVG, ¹² commended its effective handling of policy work, ¹³ the extent to which collaborative working had developed in the integrated divisions, ¹⁴ and the generally good relations at the personal level. ¹⁵ However, it claimed to identify a number of weaknesses.

4.38 Firstly, the Report considered that the 'unclear and potentially unstable' relationship between the policy Grade 3 and the CVO, with 'no clear division of responsibilities between the two', had caused some staff to feel a lack of identifiable leadership. It was also confusing to other parts of MAFF, undermined the policy Grade 3's authority, and put the CVO in the position of having to qualify his veterinary advice to Ministers 'by reference to wider policy issues'.

4.39 Secondly, there was confusion among staff about the respective roles of veterinarians and administrators. Accountability for taking policy forward was not always clear, decision-making was reserved to senior levels to an unusual extent, particularly on the veterinary side, and consultation was complicated by the different grade hierarchies. ¹⁶

4.40 Thirdly, in the non-integrated divisions, cultural barriers remained and had led to a significant number of staff expressing 'some distrust for the other side'. The confusion about roles had led to competition and tension: staff were unclear whether the veterinarians were there to provide technical support to administrators in developing policy, or whether the administrators were there to provide administrative support to the veterinarians in performing this task. 'Some administrators found the greater tendency of the veterinary side to consult upwards created awkwardness or delay.'

4.41 Finally, some staff had complained of duplication of work and of being kept in the dark about recent developments within the other discipline. ¹⁷

4.42 Mr Lawrence told the Inquiry that 'the relationship between the administrators and the veterinarians was good . . .' prior to 1990. ¹⁸ Ms Bronwen Jones and Mrs Jane Brown of MAFF's Meat Hygiene (administrative) Division considered that the merger 'made no practical difference to the way we worked with our veterinary colleagues, ¹⁹ and Mrs Brown also took the view that its reversal in 1994 did not alter things significantly. Mrs Attridge noted that the different salary structures 'did create some difficulties in having the right structure, if you had an amalgamated division'. ²⁰

4.43 Their veterinary counterparts responsible for meat hygiene told the Inquiry that 'the contact between the veterinarians in Tolworth and the administrators was extremely good', ²¹ although they were not co-located until February 1993. ²² Mr Iain Crawford (Director of the Veterinary Field Service) and Mr Keith Baker (Assistant CVO, Red Meat Hygiene) both disagreed with the conclusion of the Lebrecht Report that the merger had led to inefficiencies and weaknesses. ²³ Among their Meat Hygiene colleagues, Mr Stephen Hutchins was clear that their role was to provide 'veterinary advice which would hopefully have influenced . . . policy', and Mr Peter Soul and Mr Alick Simmons agreed. ²⁴ Mr Hutchins regarded debate between veterinarians and administrators as 'potentially, at least, quite constructive', ²⁵ and neither he, Mr Simmons nor Mr Baker recalled any evidence of the 'distrust' identified in the Lebrecht Report. ²⁶

4.44 Mr Kevin Taylor, Dr Danny Matthews and Dr Richard Cawthorne told the Inquiry that, as Animal Health veterinarians based at Tolworth, they had ignored hierarchical niceties to a considerable extent. ²⁷ However, there were cultural difficulties. Dr Matthews noted that it was not unusual for administrators, when seeking veterinary advice, to approach senior veterinarians rather than staff at working level, overlooking the fact that the former were often away from the office. Junior veterinary staff were occasionally thereby placed under 'considerable pressure because [they] had to respond to something in a hurry without being fully aware of all the background'. ²⁸ Mr Taylor commented that, occasionally, administrators newly posted to Tolworth 'initially at least were either inclined to ignore veterinary advice or not even to seek it in the first place'. Such issues were usually 'resolved on a personal level fairly quickly'. ²⁹

Department of Health (DH)

4.45 Until 1995, DH maintained parallel hierarchies of administrators and medical staff, reporting up separate management lines to the Permanent Secretary and to the CMO respectively. ³⁰ The evidence received by the Inquiry suggests that they approached the issue of how to work together effectively in a similar way to their MAFF counterparts.

4.46 A former CMO, Sir Donald Acheson, described how DH Senior Medical Officers (SMOs - Grade 5s), having been given an area of expertise, were:

. . . expected to integrate their work closely with the relevant administrative staff . . . When I needed advice in a particular field I would have a meeting which almost invariably included both the medical and administrative members of the team in question or be supplied with a jointly prepared briefing in writing. ³¹

4.47 Dr Ailsa Wight (an SMO) said that, even before the 1995 merger, she worked very closely with her administrative colleagues as part of a team and that administrators generally prepared briefings or submissions for Ministers with the assistance of medical staff. ³² An administrative colleague, Mr Roy Cunningham, confirmed this, adding that on work with a high medical or scientific content, the professionals would take the lead with the administrators providing assistance, while issues that had a high administrative or political content would remain within the purview of the latter, consulting closely with the specialists where required. ³³

4.48 On this basis, the medical side of DH took the lead in addressing BSE. Sir Kenneth Calman, who became CMO in September 1991, told the Inquiry: 'The administrative and medical sides both pre- and post-integration worked very closely in this area.' ³⁴ Miss Dora Pease (Grade 3, environmental health and food safety) recalled that:

Dr [Hilary] Pickles ³⁵ would bring in whichever Division seemed most suitable depending on the . . . BSE aspect that was in question, and also depending on matters like, I think, sheer administrative time. ³⁶

4.49 Mr Charles Lister said that his contribution, as an administrator (Grade 7), was to supplement the medical perspective with his experience of Ministers and of the workings of the Department. ³⁷ Mr Brian Bridges (Grade 3, successor to Miss Pease) enlarged on this:

It is undoubtedly true that the basic position on BSE/CJD would be formed by the scientists, by the Chief Medical Officer. But there were obviously lots of questions which flowed on from that - how you answered political interest in the matter, what sort of practical measures you promoted. ³⁸

4.50 Mr Thomas Murray, secretary to SEAC, 1990-93, told the Inquiry:

This is an area where I do not think the input from medical colleagues could be described as advice. They were an integral part of the policy team. They would help formulate decisions, recommendations and it went up the line with the blessing of both sides. ³⁹

He had previously described how his reporting lines on BSE were for the most part through the medical line, reflecting the personal interest taken by the CMO and the Deputy CMO in SEAC matters. However, he added that 'I had a responsibility to make sure that my line management [ie, senior administrators] were kept fully in the picture on developments', ⁴⁰ and that although a paper on legislation would go up the administrative line:

. . . it is fair to say that in the area of BSE and CJD very little went up the line in my time without the close involvement of my medical colleagues. ⁴¹

4.51 In 1994, a review led by a DH official, Mrs Terri Banks, assessed the system of paired administrative and medical divisions. It concluded that greater integration was necessary, because:

1. there appeared to be a lack of clarity as to where the lead lay on given areas of work, and about respective roles and responsibilities; ⁴²
2. they had found some duplication, failure to address issues and inconsistent priorities or work programmes;
3. some professionals were becoming frustrated at not being more firmly within the 'mainstream' of DH's work; and
4. the need to maintain two separate management hierarchies was inefficient, as was the use of two sets of administrative and clerical support. ⁴³

4.52 The Banks Report's recommendations led to a reorganisation of DH from April 1995 that merged the administrative and medical hierarchies and ended the line management responsibility of the CMO.

4.53 Sir Kenneth Stowe, the Permanent Secretary of DH (then the DHSS) until March 1987, recognised that such problems had existed. However, he thought that the relevance of integration to the Inquiry 'could easily be over-stated', ⁴⁴ pointing out that the issue arose in governments all over the world and that he had not yet found a solution. In his view:

. . . the organisational issue, however resolved, is no substitute for intelligent government in which every relevant discipline is identified and brought to bear on any given issue. ⁴⁵

He added that total integration within an organisation would still leave open the issue of how that organisation interfaced with others that had related or overlapping responsibilities.

4.54 Mr Murray and Miss Pease acknowledged the problems identified by the Banks Report but considered that:

. . . at a working level administrative and professional colleagues established a working relationship underpinned by understandings of who was doing what and who led in particular areas . . . I was well used to working with colleagues and establishing effective relationships that overcome some of the problems that are mentioned here. ⁴⁶

There were these problems . . . They were to our mind outweighed by the advantages of flexible and efficient multidisciplinary working . . . on food safety, no, we had no problems. Very often it was a question of who could turn their hand to the particular job in question. ⁴⁷

4.55 Mr Murray concluded that:

Throughout the 1990s, as the number of staff working on food safety, BSE, CJD increased, we became more effective at multidisciplinary team working. And I think that the formation of multidisciplinary units [has] taken that a step further in increasing the effectiveness of the operation of our resources. So I would say it is still not ideal, but it is better than maybe it was five, six, seven years ago. ⁴⁸