"In science it is observation rather than perception which plays the decisive part. But observation is a process in which we play an intensively active part. An observation is a perception, but one which is planned and prepared. We do not ‘have’ an observation (‘as we may ‘have’ a sense experience) but we ‘make’ an observation. (A navigator even ‘works’ an observation.) An observation is always preceded by a particular interest. a question, or a problem - in short, by something theoretical." (Karl Popper)
A Comment on Richard Renouf’s Critique of the Policy Review Report
Terms of Reference: Hospital Review Board
To consider the available evidence in relation to the decision of the previous States Assembly to support the proposal of the Council of Ministers that the new hospital be located on the existing site, with a view to providing assurance over this decision, or raising issues of concern in relation to the evidence that led to this decision.
Of course how those are interpreted depend a lot on what is meant by “consider the available evidence”
In his critique, part of what Richard Renouf does is to critique the remit of the board, and to argue that it has worked beyond its terms of reference. He says for example that it:
“has not focussed on determining what might be considered evidence relating to the decision of the previous States Assembly to support the proposal of the Council of Ministers that the new hospital be located on the existing site. Instead they have to a large extent heard ‘opinions’ and ‘views’ about the merits of the decision”
“Evidence is constituted by a body of facts which supports a particular proposition. Facts are not asserted. They are verifiable, auditable and assurable. That is what makes them facts. They exist independently of the person who presents them. They are open to scrutiny.”
For instance, the report itself lays out some groundwork:
Part One (sections 3-6) deals directly with the evidence review of the decision points identified in the Board’s terms of reference and scope;
- does the evidence support a single or dual site?
- does the evidence support a town or rural based site?
- does the evidence support the current site as proposed by the Council of Ministers and approved by the States Assembly?
So let us look at a rural site. The report said:
"The clinical risks and benefits had a relatively low weighting compared to other risks, such as planning, in the site selection criteria, which resulted in the process being flawed and a number of potentially alternative rural sites being rejected at the outset.”
“The views of the clinicians were not properly considered.”
So now we have something which Deputy Renouf does not include in his discussion on facts, namely when there are differing facts which are both advantages and disadvantages, how does one weigh up them and prioritise them?
This is something which the Atkins and Gleeds report attempted to do, but part of the remit of assessing the evidence cannot just be about facts but about whether the criteria they used were flawed in some way.
As we now have reports – or perhaps “facts” – from some clinicians that they were strongly instructed not to speak out publically against the choice of site, it is hard to see that this is beyond the remit and terms of reference of the board.
Which is why the report states:
“With the notable exception of the Minister for Health, the majority of the Board feel that the conclusions reached are evidence based, as supported by the opinions of individuals”
In this respect, it seems that Deputy Renout's statement - “There is a sense amongst Board members that planning should be subservient to health and indeed this aspiration is recorded in bold print in the report” - is taken out of context as it has not directly to do with planning being overruled by health considerations, but as the report says is the result of a States Workshop in 2016, which also noted that “the rezoning of green fields for development where there are clear overriding community benefits, the future planning risk can be mitigated.”
And they say: “On this basis, the Board considers that sites such as Warwick Farm could have been seen in a far more favourable light if the clinical input had been given more weight”
A Comment on Richard Renouf’s Critique of the Policy Review Report
Terms of Reference: Hospital Review Board
To consider the available evidence in relation to the decision of the previous States Assembly to support the proposal of the Council of Ministers that the new hospital be located on the existing site, with a view to providing assurance over this decision, or raising issues of concern in relation to the evidence that led to this decision.
Of course how those are interpreted depend a lot on what is meant by “consider the available evidence”
In his critique, part of what Richard Renouf does is to critique the remit of the board, and to argue that it has worked beyond its terms of reference. He says for example that it:
“has not focussed on determining what might be considered evidence relating to the decision of the previous States Assembly to support the proposal of the Council of Ministers that the new hospital be located on the existing site. Instead they have to a large extent heard ‘opinions’ and ‘views’ about the merits of the decision”
“Evidence is constituted by a body of facts which supports a particular proposition. Facts are not asserted. They are verifiable, auditable and assurable. That is what makes them facts. They exist independently of the person who presents them. They are open to scrutiny.”
For instance, the report itself lays out some groundwork:
Part One (sections 3-6) deals directly with the evidence review of the decision points identified in the Board’s terms of reference and scope;
- does the evidence support a single or dual site?
- does the evidence support a town or rural based site?
- does the evidence support the current site as proposed by the Council of Ministers and approved by the States Assembly?
So let us look at a rural site. The report said:
"The clinical risks and benefits had a relatively low weighting compared to other risks, such as planning, in the site selection criteria, which resulted in the process being flawed and a number of potentially alternative rural sites being rejected at the outset.”
“The views of the clinicians were not properly considered.”
So now we have something which Deputy Renouf does not include in his discussion on facts, namely when there are differing facts which are both advantages and disadvantages, how does one weigh up them and prioritise them?
This is something which the Atkins and Gleeds report attempted to do, but part of the remit of assessing the evidence cannot just be about facts but about whether the criteria they used were flawed in some way.
As we now have reports – or perhaps “facts” – from some clinicians that they were strongly instructed not to speak out publically against the choice of site, it is hard to see that this is beyond the remit and terms of reference of the board.
Which is why the report states:
“With the notable exception of the Minister for Health, the majority of the Board feel that the conclusions reached are evidence based, as supported by the opinions of individuals”
In this respect, it seems that Deputy Renout's statement - “There is a sense amongst Board members that planning should be subservient to health and indeed this aspiration is recorded in bold print in the report” - is taken out of context as it has not directly to do with planning being overruled by health considerations, but as the report says is the result of a States Workshop in 2016, which also noted that “the rezoning of green fields for development where there are clear overriding community benefits, the future planning risk can be mitigated.”
And they say: “On this basis, the Board considers that sites such as Warwick Farm could have been seen in a far more favourable light if the clinical input had been given more weight”
So when Richard Renouf uses the statement ““Planning should be subservient to health”” and says:
“The fact of the matter is that planning is not subservient to health and was not in 2012. Government has to comply with the requirements of the Island Plan in just the same way as citizens.”
“The fact of the matter is that planning is not subservient to health and was not in 2012. Government has to comply with the requirements of the Island Plan in just the same way as citizens.”
He is clearly ignoring the special provision in the Island Plan which allows rezoning of Green field sites for exceptional projects, and for that matter forgetting that provision was precisely what was used for the choice of Les Quennevais School site!
As my correspondent Adam Gardiner informs me, there's also something misleading about seeing Warwick Farm in terms of a Green Field site:
“Warwick Farm is only a partially Green Field site. About half is Brown > Field - which includes the greenhouses, low-level office buildings, and beyond a large storage/maintenance area and industrial shed together with various other structures. True, the site otherwise consists of 3 fields which have been spasmodically been in some sort of agricultural use - although not commercially. They were used for growing stock of various kinds or simply left fallow. I am the last person who would want to see fields built over, but rather like Quennevais School one has to take a pragmatic view on these things when it comes to essential public amenities.”
It should be remembered that Les Quennevais school also went through a selection process very similar with a “refurbishment” or current site option.
A concept study by Jersey Property Holdings (JPH) concluded: “Whilst it is physically possible to refurbish and extend, one must seriously question whether the end result would justify the expense.”
It noted that: “The need for demolition and asbestos removal would extend the construction time to five to six years.”
As my correspondent Adam Gardiner informs me, there's also something misleading about seeing Warwick Farm in terms of a Green Field site:
“Warwick Farm is only a partially Green Field site. About half is Brown > Field - which includes the greenhouses, low-level office buildings, and beyond a large storage/maintenance area and industrial shed together with various other structures. True, the site otherwise consists of 3 fields which have been spasmodically been in some sort of agricultural use - although not commercially. They were used for growing stock of various kinds or simply left fallow. I am the last person who would want to see fields built over, but rather like Quennevais School one has to take a pragmatic view on these things when it comes to essential public amenities.”
It should be remembered that Les Quennevais school also went through a selection process very similar with a “refurbishment” or current site option.
A concept study by Jersey Property Holdings (JPH) concluded: “Whilst it is physically possible to refurbish and extend, one must seriously question whether the end result would justify the expense.”
It noted that: “The need for demolition and asbestos removal would extend the construction time to five to six years.”
A new build would not have those problems, which is precisely why the site chosen for school used the special provisions in the Island Plan.
And coming back to “facts”, there is, as Karl Popper noted, no such thing as unvarnished facts. Indeed there can often been hidden assumptions which skew how the facts are considered – the history of science, a subject where you would expect to find “facts” predominating, is testament to the weakness of an approach which assumed that facts are not theory-laden in some was, because how they are selected, interpreted and used is always in the context of some pre-existing ideas, and can be blinkered.
A reading of Popper ("Objective Knowledge") or Thomas Kuhn ("The Structure of Scientific Revolutions") would be instructive in this respect. For instance, Gleeds decided which facts to collect as significant, and how to weigh them in making decisions for choice of site. Whether this process was correct or not is not a matter of "facts" but of opinions which may be argued for particular choices made in how the facts fed into site selection.
And coming back to “facts”, there is, as Karl Popper noted, no such thing as unvarnished facts. Indeed there can often been hidden assumptions which skew how the facts are considered – the history of science, a subject where you would expect to find “facts” predominating, is testament to the weakness of an approach which assumed that facts are not theory-laden in some was, because how they are selected, interpreted and used is always in the context of some pre-existing ideas, and can be blinkered.
A reading of Popper ("Objective Knowledge") or Thomas Kuhn ("The Structure of Scientific Revolutions") would be instructive in this respect. For instance, Gleeds decided which facts to collect as significant, and how to weigh them in making decisions for choice of site. Whether this process was correct or not is not a matter of "facts" but of opinions which may be argued for particular choices made in how the facts fed into site selection.
That is important because there seems to be an unquestioned idée fixe that prioritises a hospital in the close environs of St Helier's rather than outside, which is seen as less accessible - hence Warwick Farm, Overdale and St Saviours all have flagged up accessibility issues, whereas Gloucester St, People's Park and the Waterfront don't. The Waterfront and People's Park have both fallen mainly because of political issues, leaving just Gloucester Street.
How they manage in Guernsey goodness only knows!! There is an inability to think outside the St Helier Town Centre Box, which seems akin to a kind of inherent weakness in terms of how facts are weighed. Guernsey clearly manages very well with an out-of-town General Hospital, and this was not considered in the factoring of site suitability, and yet they manage perfectly well.
In conclusion, by questioning the terms of reference of the Board, and by making an artificial distinction between fact and opinion, Richard Renouf's critique demonstrates methodological weaknesses of its own.
As Cortlet Novis points out:
"The traditional view of science, which largely endures today [in popular culture], is that theories and models are distinct from the observations we make. In other words, fact is independent of theory."
But he says that is mistaken:
"Science needs to start with more than just “observation” but rather with a pre-existing theoretical framework from which to seek out and make sense of observations. Scientists need something to expect and they need to know where to look. Two people may look down a microscope and see completely different things depending on what theoretical framework they are using. "
The distinction between "views" and "facts" which is made by the Health Minister, I would argue, is a similarly egregious mistake in method which vitiates much of his critique.
How they manage in Guernsey goodness only knows!! There is an inability to think outside the St Helier Town Centre Box, which seems akin to a kind of inherent weakness in terms of how facts are weighed. Guernsey clearly manages very well with an out-of-town General Hospital, and this was not considered in the factoring of site suitability, and yet they manage perfectly well.
In conclusion, by questioning the terms of reference of the Board, and by making an artificial distinction between fact and opinion, Richard Renouf's critique demonstrates methodological weaknesses of its own.
As Cortlet Novis points out:
"The traditional view of science, which largely endures today [in popular culture], is that theories and models are distinct from the observations we make. In other words, fact is independent of theory."
But he says that is mistaken:
"Science needs to start with more than just “observation” but rather with a pre-existing theoretical framework from which to seek out and make sense of observations. Scientists need something to expect and they need to know where to look. Two people may look down a microscope and see completely different things depending on what theoretical framework they are using. "
The distinction between "views" and "facts" which is made by the Health Minister, I would argue, is a similarly egregious mistake in method which vitiates much of his critique.
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