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Re: All surveys may have ethical implications

Dear Editor,

I read with interest the recent review by Beardsmore and Westaway regarding the National Patient Safety Agencys (NPSA) ad hoc advisory group consultation document on the future of research ethics committees services (1). The implementation plan for the recommendations of this document has now been approved by the Department of Health. The authors report that the first of these recommendations suggests that the remit of National Health Service Research Ethics Committees (RECs) ‘should not include surveys or other non-research activity if they present no material ethical issues for human participants’. This may be open to misinterpretation and could become a source of confusion. Many prospective descriptive research studies may utilise a questionnaire to ‘survey’ responses of participants, however other surveys may be carried out which are clearly not research. Examples of the latter are surveys relating to clinical audit where performance against a standard is being assessed and operational surveys where working practices are being evaluated (for example patient satisfaction questionnaires and clinic waiting time monitoring). All of these types of survey have the potential to give rise to ethical issues such as data protection, undue coercion of respondents and the possibility of overburdening patients or their carers with multiple questionnaires. It is not for those carrying out any of these surveys to decide whether there is any ‘material ethical issue’ involved as they have a vested interest in carrying out the work. I believe that if a study (whether it be paediatric or adult) which includes a survey is truly trying to answer a research question it should be reviewed by an REC who should give a view on the ethical issues involved. There is still work to be done however to make ethical review of this sort of study uncomplicated, timely and robust. There is no consistency across the country as to what committees, if any, are available to review the ethical issues that could be involved in the other types of survey that may be carried out. In the trust I work in the ‘Audit and Quality committee’ takes on this role.

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