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 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.

1. The Building Blocks Of Independence
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 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’.

2. 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 judgment without fear or favour. That
means two things:
● Independence of activity - that they are free from external control or influence
● Independence of mind – there are good controls to minimise internal bias or subjectivity
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 judgment, 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 to discredit a review, this may be because of the
funding flow or conflicts of interest. Looking at both of those:
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 performance or that of their colleagues.
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

3. 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 a 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:
● hindsight bias – the tendency to overestimate one’s ability to have
foreseen an outcome. “I knew it all along.”
● projection – displacing one’s feelings onto someone else
● confirmation bias – the tendency to favour information that confirms
existing beliefs or values
● selection bias – engaging with people who are not representative of the
overall group of interest
● self-serving bias – attributing our successes to our efforts, and our
failures to the actions of others, or external events
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.
● Relationships and conflicts: Conflicts can arise in many forms. For example, if any of
the independent reviewers (or close family members) have worked in close association
with the client or any close proxy organisations as a person of significant influence, the
conflict is probably irreconcilable. Similarly, if a person has expressed a set of views it
might compromise independence. In these cases, different individuals should ideally be
allocated to the review.
● Conflict management: NHS England has issued helpful guidance on managing
Conflicts of Interest[1]. Central to the guidance is the principle of total transparency; not
declaring conflicts (actual or perceived) can be hugely damaging. Ideally, conflicts should
be avoided but if, as above, there is no choice but to use someone on an independent
review panel (such as a super-specialist) who might have an actual, potential, or
perceived conflict, then managing that conflict appropriately is essential, using the
guidance referred to here.
● Checks and balances: Providing judgements based upon solid evidence is the biggest
safeguard of independence. Evidence must be triangulated, for example, by combining
interview feedback, survey data, documentation and audit information to provide a

4. rounded view. Evidence must be reliable; if it is not, it must be stated as such, or
additional work must be done to confirm or discount the reliability of evidence.
● Trust and truth: It is the job of an independent review to take swathes of information
(sometimes running to millions of lines) and to evaluate, cross-reference and consolidate
all of this into an accessible and reasoned view. Transparency does not mean making
interview transcripts, private letters or privileged or supplementary advice freely available
to anyone; if this were the case, then no one would want to talk to an independent
reviewer openly, as there would be no trust.
● Validation and accountability: No reports should ever be finalised without proper
factual accuracy checking having taken place. This includes offering a right of reply on
all reports, and Maxwellisation[2] on public reports. This is a key moment when people
who are receiving a report can identify any issues they see with the basis for the
findings. Any changes to the report, along with the rationale for change, should be fully
recorded and made available to those who require assurances about changes made.
● The end product: Being particularly critical in a report should not be the only defining
factor of independence – but, if there has been a balanced view applied to the review
findings, this should be a reasonable indication that independence has been applied. In
short, the report should speak for itself.
How to improve independence – overall approaches
In addition to proper professional practice in delivery there are overall actions that support
independence:
● The integrity of advice: Independent reviews can broadly fall into two main categories:
audit (assessment) and advice (development). If an independent reviewer (firm or
individual) has provided audit or advice services within the last 3-6 years, then there
should be significant hesitancy applied in allowing the firm to switch those positions. In
FCA-regulated firms, this is why ‘Chinese Walls’ are implemented and taken seriously,
as there is a real risk of failed independence. Often called ‘marking own homework’ this
is when a firm provides advice which it then evaluates or judges; either one or the other
is usually acceptable on a consecutive basis.
● Commissioning transparency: Frameworks are a transparent route to procurement
for the public sector, and they are aimed at ensuring that existing relationships cannot
influence key appointments. This means that extensive tests must be met by providers
before they can bid for work, and awards should be based upon both a subjective (by
the firm) and an objective (by the contract awarding body) assessment of independence.
All major independent reviews, particularly developmental well-led reviews, external
audits and independent investigations should be centrally commissioned by an impartial
body to avoid conflicted relationships, inducements and incentives. ‘Cosy’ relationships
should be both avoided and prohibited.
● Funding: Funding arrangements should be carefully considered, and it is far better when
the party under investigation is not also the bill-payer. When independent reviews are
funded directly by the client (for example by a Trust) there also tends to be a greater
involvement of lawyers who are seeking to protect the direct interest of their clients. This
is a problem that is increasingly an issue in independent reviews and can lead to months
of dispute as the independent reviewer battles to allow the facts to surface without
impediment.

5. 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 expensive[3] 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 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, that can 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 the 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 that 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.
[1]
https://www.england.nhs.uk/wp-content/uploads/2017/02/guidance-managing-conflicts-of-interes
t-nhs.pdf
[2] the legal practice in English and Scots law that allows anyone who is criticised in an official
report to respond before publication, based on details of the criticism received in advance.
[3] In 2015 the budget for the Audit Commission was £213 million.