The Week

The Week 27 October 2023

It’s been a busy week for policy wonks.

A briefing paper published Tuesday discussed how Whitehall can be better equipped to deliver for citizens. On Wednesday, Lord Maude, former Cabinet Office minister, discussed recommendations from his forthcoming review of the Civil Service. And yesterday, new research revealed a ‘hidden’ waitlist of over 11 million appointments for follow-up care — in addition to the 7.75 million waitlist for elective care.

The golden thread? Other than each of these being Reform’s handiwork, they all point to the crucial importance of high-quality data and transparency in policymaking.

In the first instance, as our briefing paper says, high-quality data held across government can help establish a “single truth”, so that everyone working on a project or policy is clear on progress made, and areas that require greater attention. Too often, however, sharing data between departments is much easier said than done. Reform has previously heard examples of departments having to buy data from other departments, despite major benefits to the public going unrealised unless this data is shared.

Next, as Lord Maude argued at our exclusive 'in conversation' event ahead of the publication of his review, high-quality performance information is essential to ensure public sector leaders are making smart day-to-day decisions about the programmes they run. Yet, as our recent paper An efficiency mindset noted, even very basic management information (regarding FTE headcounts or the resources allocated to key programmes) is often worryingly absent. As Lord Maude rightly pointed out at our event, this information is vital if government is going to improve its delivery record and “essential to accountability”.

Finally and perhaps most importantly: what gets measured gets done. The data that’s most readily available and transparent is the data that’s typically used to hold departments to account and that senior leaders focus their efforts on. In the case of the NHS, this effectively means the data used to track its national targets: the 4-hour A&E target; the 18-week wait for elective care; and the 62-day standard for referral-to-treatment for cancer patients.

Of course, each are important, well-justified aims — setting out standards that patients should be able to expect from an effective health system, capable of providing timely care. What they are not, however, is exhaustive. We know, for example, that there are a huge number of patients waiting for essential, non-elective care: appointments that could help detect the recurrence of cancer, detect complications post-surgery or prevent the deterioration of conditions.

These non-elective waits, or “follow-up appointments”, were the focus of Reform’s new report out yesterday. NHS acute trusts are under no obligation to publish this data, which means they don't. We had to use a Freedom of Information request to obtain the data, and then estimated the total waitlist — nearly half of trusts could not, or failed to, provide information on their waitlists. We estimated that there are now more than 11 million appointments, 50% more than pre-pandemic and 3.6 million more than the elective waitlist.

NHS England responded to the report arguing that “these types of appointments are…routine follow-up appointments after treatment has occurred, and in many cases patients may be booked for multiple appointments”. Which is true, but the problem is that they don't know what's going on with these lists, and so we don't know what the risks to patients are, or whether the highest risk patients are being prioritised. Just because an appointment is “routine” doesn't make it unimportant — as The Royal College of Ophthalmologists has pointed out permanent harm from avoidable visual loss is 9 times more likely in follow-up patients than in new patients.

Until trusts record and report this data, hospitals are unlikely to be able to effectively manage their follow-up waitlists, and that risks the health and safety of patients.

Public trust and confidence depends on transparency. As does effective policymaking.

Onto our read of the week…

On the AI front, there was a blitz of news from the Government on Thursday — including a major speech by the Prime Minister at The Royal Society and a three-part paper on the risks and opportunities of frontier AI. This is all part of the lead up to the global AI Safety Summit taking place at Bletchley Park next week.

The main policy news in the PM's speech — aside from a promised £100m extra to accelerate the use of AI to support treatments for "previously incurable diseases" — was his announcement of the world's first AI Safety Institute, based in the UK. Its role will be to test new types and models of AI and examine the risks they present, across areas like misinformation and bias against particular groups.

The details were pretty light, so this is a 'wait and see'. We might see further developments next week during the Summit. But, for now, it is promising that a PM under plenty of short-term political pressure to try and turn things around, especially after two major by-election losses, is still finding space for some proper long-term thinking.