Honours, freedom of information and the control of medicines

Early in 2005, within a few days of the belated introduction of the Freedom Act 2000, I wrote to the relevant committee at No 10 Downing Street to ask for information about the decision to honour two stalwarts of the UK medicines control system. How much official information was available to explain the decision (2003/4) to reward the MHRA Chairman, Professor Alasdair Breckenridge, with a Knighthood, and to create his former Head of Executive Support, Mr Roy Alder, a Commander of the Order of the British Empire, (2004/5). To recap:

Knighthoods are awarded for: "Pre-eminent contribution in any field, usually, but not exclusively, at national level, or in a capacity which will be recognised by peer groups as inspirational and significant nationally, and which demonstrates sustained commitment and/or public service."

The CBE is awarded for "a prominent national role of a lesser degree, or a conspicuous leading role in regional affairs or the public service; or making a highly distinguished, innovative contribution to his or her area of activity."

This both was and was not a futile request. On the one hand, the Freedom of Information (FOI) Act specifically denies the public any right to any information about the Honours system and process – a point belatedly and solemnly conveyed by a Mr Daniel Thornton of 10 Downing Street. On the other hand, the restriction seems absurd, inappropriate, damaging – especially in the light of the present criminal investigation of the "cash/loans for honours" system.

Absurd? Look at it, say, through the eyes of the Americans or the French – in different ways, both masters of ceremony and accolade. They might well wonder what kind of a national honours system makes it a criminal offence to divulge details of the contributions people made to deserve high honour. What credible institution – even a university - would ever honour its chosen few without some fulsome citation, to explain why they deserved public gratitude and recognition? Yet the FOI Act categorically denies people the right even to question what is officially deemed to be deserved.

Inappropriate? Yes, for all kinds of reasons, including doing great disservice to the deserving: why should their light be hidden under an official bushel? Even if we’ve got used to it, a secretive honours system seems, on principle, a national disgrace: people should have reason to appreciate, even celebrate the appointment of lords, knights and lesser orders. How great and good are the results, when Honours Lists are compiled in Downing Street and Whitehall, albeit with a few tweaks from Buckingham Palace along the way?

Why dangerous? The short answer hangs on the reality: that the Honours System is still much revered; that the prospect of an award is intensely seductive; that being offered an Honour is generally extremely welcome; and that titles/letters before and/or after your name is generally very pleasing and rewarding. It follows that those in a position to propose or secure Honours hold great unaccounted for power, with all that this implies.

Power without accountability is always dangerous. Leaving aside the deeply unsavoury evidence of ‘cash for honours’, we are still left with the routine problem of "perverse compliance". Albeit from a great distance, I have seen and felt the Honours system at work, and think of it as an important dynamic in the medicines control system. No names, of course, but there is never any shortage of administrators and professionals caught up in this system, some of whom truly crave the Honours their positions might bring. Far be it from them to rock the executive boat, and far be it from the executive to embarrass the political leadership – and just look at the results.

I have commented in the past on the decisions to honour Sir Alasdair and Roy Alder CBE, but what of the next in line? The pecking order is all too obvious, but what of merit? This is a hard call because, collectively, the senior medicines’ control people have failed dismally yet, individually, their application, integrity and commitment are hardly in doubt. The stupendous mess the authorities have made in controlling antidepressants over the past decade is clearly part of a pattern of failure. Remember the conclusion of the Parliamentary Health Committee, following its lengthy investigation (2004/2005) into "The Influence of the Pharmaceutical Industry":

"During this long inquiry we became aware of serious weaknesses in the MHRA. Worryingly, in both its written and oral evidence the Agency seemed oblivious to the critical views of outsiders and unable to accept that it had any obvious shortcomings, except those that could be remedied by more transparency. The Agency’s attitude to its public health responsibilities suggested some complacency and a lack of requisite competency, reducing our confidence in its ability to undertake the reforms needed to earn and deserve public trust. Nor did we conclude that the MHRA provides the discipline and leadership that this powerful industry needs. We recommend that there be an independent review of the MHRA …" (paragraph 376)

The government rejected this proposal, of course. Meanwhile, the Birthday Honours list is now due.

Charles Medawa
15 June 2006