The Swedish Agency for Public Management
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Analysis of the Swedish National Council on Medical Ethics (2018:20)

Statskontoret (The Swedish Agency for Public Management) has conducted an analysis of the Swedish National Council on Medical Ethics (Smer) on behalf of the Swedish Government.

The Government decided in 1985 to set up the Swedish National Council on Medical Ethics for the purpose of disseminating knowledge, providing advice and stimulating debate on medical ethics issues based on a general societal perspective. The Government stated at the time that it was neither advisable nor necessary to specifically define Smer's tasks. Furthermore, the Government also emphasised that Smer was to be independent from ongoing government work and be free to address the issues that they consider to be important. Smer's commission and organisational form has not changed since its inception more than 30 years ago.

Smer is a small organisation with broad activities

Smer is a small organisation involved in a broad range of activities. Smer comprises a chairperson, eight politically elected members and eleven experts. The body has a small Secretariat as support and a budget of SEK 4 million for 2018. Smer's organisation differs from other governmental organisations as it is neither a government agency, a committee nor a working group in the Government Offices.

It produces reports and other official documents and comments on proposals referred for consideration. Smer also conducts external monitoring and organises conferences and seminars. The Council writes opinion pieces in the press and maintains a media presence, and also takes part in international collaborations.

Statskontoret's analysis shows that Smer's main target groups are the Government, the Swedish Parliament, county councils and regions, as well as certain government agencies such as the National Board of Health and Welfare and the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU).

Smer fulfils its remit despite limited resources

The assessment of Statskontoret is that Smer on the whole fulfils its commission through carrying out all tasks specified by the Government. The operation is also conducted with limited resources, which indicates that it is cost-effective.

The target groups have a high level of confidence in Smer

Our analysis shows that all target groups perceive Smer to be a serious and legitimate actor. They consider Smer to have a high level of competence in terms of analysing and assessing emerging medical ethics issues, that the publications produced are of good quality, and that Smer's opinions carry weight. The target groups emphasise that it is a strength that the Council is composed of representatives from different organisations and agencies as well as politicians. It is also important for Smer's legitimacy that the Council is perceived as independent.

Smer provides added value in relation to other organisations

There are several other organisations that handle issues which require an ethical perspective. As the activities of Smer touch upon activities of other organisations, there is a risk that the work of the Council will overlap with that of other organisations. Our analysis shows that Smer avoids this through external monitoring, dialogue and collaboration.

Although there may be instances of overlapping in choice of topic, our assessment is that the production constitutes added value as Smer adopts a unique position within the area. This is due to the fact that politicians and experts on the Council represent different perspectives that allow Smer to highlight the medical ethics issues through applying a holistic perspective, which other actors are unable to contribute.

Operations can be more efficient

Although Smer fulfils its commission, Statskontoret finds there to be room for increased efficiency. Smer's commission and organisation need to be clarified and the number of target groups needs to be reduced.
The numerous tasks that Smer is working on means that each initiative is restricted by the resources available to the Council. Uncertainties regarding what type of organisation Smer is also lead the Government and Ministry of Health and Social Affairs being unsure about how to control and monitor Smer's activities. Our analysis also shows that the usefulness for individual target groups is often low, despite Smer's publications being considered to maintain a high level of quality.

Statskontoret proposes that Smer become a permanent committee

Several of the factors preventing efficiency in its activities can be addressed if Smer's organisational form and commission are clarified. The assessment of Statskontoret is that classification as a committee is the most appropriate form for Smer's future organisation. The committee form would clarify Smer's organisational status without impacting its activities to any major extent. The conversion costs would therefore be lower compared to other alternatives, while the status as a committee can preserve those part of Smer's operations that work well.

Statskontoret's recommendation means that the activities of Smer moving forward would be governed by a committee terms of reference. According to Statskontoret, the terms of reference should contain the following:

  • a refinement of Smer's role
  • a delimitation of Smer's target groups and tasks
  • clarification of what support Smer should provide to government agencies and county councils
  • the continued possibility for Smer to choose relevant issues
  • clarification of which competencies are to be included in Smer
  • new rules for appointment.

In addition to the terms of reference, the Government should also consider allowing Smer to be part of the structure for knowledge management, which aims to provide health and social care based on the best available knowledge.