Reflections on applying for NHS ethical approval and governance in a climate of rapid change: prioritising process over principles

Ethical review and governance of health services research in the UK have undergone significant changes in recent years. Tracing this incremental development helps to understand the rationale for introducing a more standardised process. Reflecting on our experience of approval for a national, multi-centred, qualitative study provides useful insights into both the advantages and disadvantages of this new approach. Advantages include promoting awareness of ethical issues and timely review of proposals. However, excessive bureaucracy and inconsistency in obtaining local governance approvals can lead to unacceptable delays. There is also a danger that the current focus on the process of applying for ethical approval may overshadow debate about the principles of ethical research practice. Over-reliance on a checklist approach may perpetuate an erroneous notion of ethical approval being a ‘hurdle’ to negotiate instead of an ongoing consideration. Unanticipated theoretical and methodological implications for future health services research are critically examined. Given the continued globalisation of health services research, this discussion may help inform debates and decisions about restructuring ethical review processes in other countries