Appendix 5: Note by the Specialist Adviser, Emma Norris: An audit of independent and semi-independent public bodies and implications for a new health and social care body
The audit
During the course of the inquiry, the Committee heard the suggestion that a body should be established to guarantee cross-party agreement for long-term health policy and planning. Some witnesses suggested that this may be achieved through an independent body charged with (1) setting the strategic direction of health spending, workforce planning and models of delivery and/or (2) acting as a custodian of accurate data relating to health and social care.
To assist the Committee consider this suggestion in greater detail, I have produced a general audit of the different models on which an independent or semi-independent body established to guarantee the long-term sustainability of the NHS and social care might operate and the different roles such a body might play. I have done this by selecting public bodies from a range of areas—from policing, to social mobility, to infrastructure—and applying to them a series of questions about their purpose, functions, outputs, composition and impact. In doing so I have drawn extensively on work completed within the Institute for Government by Joshua Harris, Jill Rutter and Euan McCarthy. I am most grateful for their efforts.
In total, I surveyed 16 bodies and categorised them according to the following typology, which indicates their primary role:
Body |
Abbreviation used in note |
Primary role |
|
Audit Commission |
AC |
Auditor, advisor |
|
Committee on Climate Change |
CCC |
Analytical advisor, monitor |
|
Education Funding Agency |
EFA |
Funding distributor, monitor |
|
Higher Education Funding Council for England |
HEFCE |
Funding distributor, regulator |
|
Independent Commission for Aid Impact |
ICAI |
Monitor |
|
Low Pay Commission |
LPC |
Analytical advisor |
|
Migration Advisory Committee |
MAC |
Analytical advisor |
|
National Audit Office |
NAO |
Auditor, improvement agency |
|
National Infrastructure Commission |
NIC |
Analytical advisor, improvement agency |
|
National Police Improvement Agency |
NPIA |
Technical adviser, improvement agency |
|
National Institute for Health and Care Excellence |
NICE |
Advisor, regulator |
|
Office for Budget Responsibility |
OBR |
Analytical forecaster monitor |
|
Ofcom |
Ofcom |
Regulator |
|
Review Body on Doctors’ and Dentists’ Remuneration |
DDRB |
Analytical advisor |
|
Social Mobility Commission |
SMC |
Analytical advisor, advocate |
|
UK Statistics Authority (including Office for National Statistics) |
UKSA ONS |
Data producer, regulator |
I looked across these sixteen bodies and drew out and analysed common features, before concluding with the implications and questions that arise for a consideration of any potential independent body looking at health and social care. The full audit of each body can be viewed on the Committee’s website at www.parliament.uk/nhs-sustainability
Role, purpose and powers
Most independent bodies I considered had a clearly articulated and widely understood scope and purpose. This enabled them to focus, made it clearer what value the body offered, and prevented creeping scope—the lack of this is an existential risk. This proved true in the case of the Audit Commission which was abolished by the Coalition Government in 2015 (announced 2010), in large part at least due to it being seen to have “lost its way” as the then Secretary of State for Communities and Local Government, Eric Pickles, said.314 Advisory bodies are typically set up to answer a single or narrow set of questions on which independent expert advice is needed to depoliticise the decision, or resolve conflict.
As the typology above indicates, most bodies I looked at perform an analytical and/or advisory function, some with additional responsibilities as an improvement agency—that is, to support improvements rather than just advise on or monitor them—a regulator or auditor. Of relevance to a potential health body is the monitoring role of bodies which exist to track the implementation of Government performance against a certain standard, such as the CCC with climate commitments and the OBR which assesses whether the Government is on track to meet its fiscal rules.
Irrespective of statutory status (discussed below), all bodies have a written purpose and remit, such as a Framework Agreement, Memorandum of Understanding, or annual remit letter from a minister. Several, like the ICAI, often still have some form of written framework agreement with their sponsoring department.315 Those which undertake regular reports will often be guided by a remit letter from their sponsor setting out the terms under which they should work. For example, the NIC receives one from the Chancellor of the Exchequer316 and the DDRB receives one from the Department of Health317 as well as from the Chief Secretary to the Treasury setting out Government policy on public sector pay.318
The political context is important, and related to the organisation’s role and purpose as far as there is consensus agreement on the purpose of the body. This reduces the frictional cost of bodies operating—for example, avoiding diverting attention to combating hostile press attacks or having its independence and impartiality undermined or questioned. But it also provides greater surety of longevity in case there is a change of minister or Government. The NIC, for example, was set up by a Conservative Government but had also been a Labour party manifesto promise following their own independent review of UK infrastructure by Sir John Armitt, who is now Deputy Chair of the NIC, which they commissioned while in opposition.319 The difficulty of taking decisions about major infrastructure projects in Government—notably airport capacity and HS2—convinced many of the need of an independent, objective assessment of what infrastructure the UK requires, and what could be done within a set fiscal envelope. The previous Labour Government’s Infrastructure Planning Commission was established in October 2009320 with some of the same functions, but also a remit on planning decisions but never enjoyed cross-party support and was finally abolished by the Coalition Government in 2012321 with its planning functions transferred to the Planning Inspectorate.
Though typically separated from executive functions, some independent bodies take on functions which otherwise would be performed by a department. For example, the OBR took over Treasury responsibility for published fiscal forecasts, and the EFA, while remaining part of the Department for Education and responsible to ministers, has taken over functions previously located in the core department. Few have direct executive powers: NICE’s control over drugs and medical technology in the NHS is a rare example.
No independent body I considered had direct control over levels of public spending. It is quite common for Government to use arm’s length bodies to distribute funding (as the EFA and HEFCE do in my sample) but none determine the quantum. Some can make recommendations which have implications for Government spending—for example the LPC and the DDRB. But in both cases final decisions rest with Government, not the body, and Government evidence to the DDRB, and other pay review bodies, focuses on affordability.
Where they do not replace departmental functions, but add additional capability, bodies need to have a clear landing point for recommendations. For bodies with an advisory role, this can be direct to ministers (though reports are often, for transparency, also published), parliament (as set out below) or to professionals for whom the advice is intended (such as the NPIA for police). Most bodies can produce additional analysis when requested by ministers, such as the CCC and DDRB.322
Parliament is the landing point for several of the bodies I considered, and a parliamentary process of scrutiny offers additional protection against reports being controlled or ‘buried’ by ministers. The NAO provides the analysis and evidence to support the House of Commons Public Accounts Committee, a powerful partnership. Similar to this model, the ICAI has been designed to service a dedicated sub-committee of the House of Commons International Development Select Committee, requiring the Department for International Development to submit its response to ICAI reports to parliament and giving ICAI parliamentary backing to its follow up on how recommendations are implemented. Andrew Mitchell, who as Secretary of State for International Development established the ICAI, later said of it, “Ministers can just sweep inconvenient truths under the carpet. But we set up this Commission to report not to ministers but to the legislature”.323 Many of the other bodies are required to lay their reports before parliament which ensures a minimum of transparency.
A small number of bodies I considered have additional mandates to play a more active advocate role within Government or a delivery system. This can be technical, advocating best practice: the Audit Commission recommended best practice at a local level, based on its research, and the NPIA was specifically set up as an improvement agency to support police forces. Or it can be about advocating a cause: the SMC has a mandate to promote social mobility among employers, professions, universities, and schools. However, this advocacy role can lead bodies into more direct conflict with Government and, as was the case for instance with the Sustainable Development Commission (2000–2011), lead to their abolition if ministers no longer see the value in funding an arm’s length critic.324
Several bodies I considered have an explicit stakeholder engagement role. Sometimes this is simply necessary for the body to perform its role: the EFA and HEFCE must work with the institutions they fund, the NPIA with police, the AC and NAO with the bodies it audited and their service users, and Ofcom with the broadcasters it regulates.
Others exist to independently engage representative stakeholders to build consensus around a decision which otherwise could be politically difficult or controversial. For example, the LPC exists to build consensus around the minimum wage rate and therefore is comprised of employer and employee representatives as well as independents. The DDRB, like other pay review bodies, is intended to resolve conflict between Government and public sector workers by independently setting pay levels, considering the need to motivate and recruit staff as well as the department’s budget. It is comprised of independent members, albeit many with former health sector (though not clinical) experience, but takes evidence from bodies including the department.
Less typical is an explicit role in direct public engagement–rather than through stakeholder and representative groups—or wider consultation on behalf of Government. NICE does have a ‘Citizen’s Council’ panel of public members to ensure it considers views of the public on a regular basis, as part of a wider programme of public engagement.325 Most others carry out ad hoc consultations or calls for evidence as required, for example recently by the NIC326 but these are usually targeted at specific groups or interested parties than the general public. HEFCE run the National Student Survey, which is an annual exercise in seeking user views. It is arguable that an independent body carrying out a consultation is more credible than one done by the department—and there are effective tools available to do so—but there is limited evidence of bodies successfully building up meaningful public engagement on an ongoing basis.
Form and status
Form does not determine the success or independence of an organisation but can provide insulation from interference. The Institute for Government has argued that there is a clear case for form following function and that the key determinant of this should be the degree of freedom the body needs from ministerial control to perform its functions effectively. The Institute proposed that the existing classification of arm’s length bodies should be overhauled and a new category of “public interest body” should be created for watchdog and regulatory bodies whose credibility depended on their independence from ministers.327 The Government launched its own review of classifications in 2015 and produced guidance which stresses the organisation form for new bodies should be determined inter alia by their need for independence from ministers.328 The bodies I considered range from executive agencies, which are constituent parts of departments (EFA, NIC) through mostly advisory non-departmental public bodies (NDPBs) to, at the most independent and secure status end of the spectrum, a public corporation (Audit Commission) and parliamentary body (NAO).
Classification matters because institutional arrangement determines how ministers can change the organisation. Some, but not all of the bodies I looked at are grounded in statute. Executive agencies and many advisory NDPBs exist at ministerial discretion, with their staff remaining civil servants; other bodies are usually (but not always) established in statute. Putting bodies on a statutory basis means ministers must pass primary legislation to abolish or substantially change a body.329 In the absence of a formal institutional separation bodies depend on ministerial forbearance for their actual independence. The recent announcement that the NIC would be made an executive agency of the Treasury—i.e. remaining a constituent part of it, responsible to and controlled by ministers—raised questions about how long its actual independence will last.330 Executive Agencies can be absorbed on ministerial whim because there is no constitutional separation between them and their parent department. This has happened with operational delivery agencies, as when the UK Border Agency was reabsorbed back into the Home Office with no warning in 2013. However, even strong statutory protections do not mean bodies can avoid political risk altogether. Being based in statute did not prevent the abolition of the Audit Commission or NPIA, and the Social Mobility Commission lost its original remit for monitoring child poverty.
Statutory status can also prevent organisations from mission creep by constraining its role. For example, in the run up to the 2015 general election there was pressure for the OBR to cost election manifestos, which its Chairman, Robert Chote, explained to parliament was a potentially very complex change to make to its role, and while he supported it in principle, required serious consideration before implementing.331 Since the OBR could not fulfil this role without a change to legislation, this meant the OBR could resist the pressure until and unless parliament deemed otherwise.
Independence
First, the popularity and support for certain independent bodies—especially the OBR currently—and general acceptance of others—like the NAO—suggests they continue to play a useful role for ministers. Indeed, several of the more significant bodies I considered including the OBR, NIC and ICAI were set up by a Government otherwise committed to a ‘bonfire of the quangos’. Of the ICAI, Andrew Mitchell, the then Secretary of State, said later of it, “the ICAI could be very testing and very difficult, but they did a good job, a very important job”.332 At the most recent Autumn Statement, the Chancellor of the Exchequer, Philip Hammond, remarked that due to the OBR’s forecasts, “gone are the days when the Chancellor could mark his own homework”.333 Of course, this does not apply universally to independent bodies and some have fallen out of favour, as the abolition of the Audit Commission and NPIA demonstrates.334 In his recent book, Ed Balls describes the benefits to politicians of arm’s length bodies: “Following the success of Bank of England independence the idea of handing over power and control to experts and suitable bodies took hold. The Government would establish the objective, the structure and the rules for an institution, but hand over control to an arm’s length agency to make the case-by–case decisions on the basis they would be able to take a long-term, proactive approach, undeterred by short-term political pressures”.335
Small advisory bodies are used to try and take heat out of political arguments or defer decisions: recently this has included the Secretary of State for Health asking the DDRB to review suggested contract changes for doctors336, and the MAC being commissioned to review Tier 2 visas.337
Second, bodies differed over the level of autonomy they exercised over their workplan, and whether they have their own power to act, or whether they can only do so at ministerial behest.
(a)Where their purpose is advisory, it makes sense for this to be on demand, as with the MAC, to avoid producing advice which is not needed. Even where bodies determine their own workload, it is prudent to work on areas which are of relevance and value. However, where bodies have more of a monitoring function it is important that they have significant freedom to determine their own investigations. This is of course crucial for audit bodies like the NAO, and when others are acting in an inspection or regulatory capacity like Ofcom, HEFCE, EFA and the UKSA. But is also important for bodies like the ICAI to be able to have a workplan determined independently of ministers, in that case when it is agreed with the House of Commons International Development Committee.
(b)Other bodies have a regular rhythm of operation which means their freedom to act is not questioned because they do not need a mandate for each piece of work. For example the OBR is required to produce forecasts and analysis for fiscal events, and annually such as on compliance with the welfare cap. The LPC and DDRB produce annual outputs. The CCC produces annual progress reports to parliament on “meeting carbon budgets”.
(c)Where bodies act on the basis of ministerial instruction, these are best written and published to ensure transparency and accountability. Many of the bodies work within parameters set by ministers, which are then published: the Charter for Budget Responsibility sets out the Government’s approach to fiscal policy for the OBR for example. The DDRB and NIC both receive remit letters from ministers for each report.
Third, an independent body requires secure funding to avoid ministers neutering it through unscrutinised cuts to its funding—or by withholding resources required to undertake investigations. The NAO, which has its budget direct from parliament, has the most secure funding. But at least bodies with non-ministerial department status have a separately identifiable budget line so that any punitive cuts to its funding following a spat with the minister can be seen. When the Treasury opted to keep the OBR as part of the department (albeit as a body corporate established in statute), it agreed to give it a separate budget line in Treasury accounts for this reason. Those which do not have these protections risk having pressure applied to their funding—or simply having their resource cut along with the department as a savings measure, which may inhibit the ability of the body to perform its function as effectively as it would like. Bodies have also been subjected to the wider Cabinet Office controls on spending which can affect their ability to hire consultants. This has been a source of tension between public bodies, departments and the Cabinet Office.338
Fourth, leaders of independent bodies need to feel sufficiently secure in their post to resist political pressure—and they need to be credible candidates rather than ministerial ‘placemen’. Thus a number of the bodies I considered had legislative safeguards against leaders being ditched unilaterally by ministers, or to prevent inappropriate appointments.
(a)Parliament has a role in some appointments.339 The NAO has the strongest protection against the removal of the Comptroller and Auditor General, who as an Officer of the House of Commons can only be appointed or removed by parliament, and the address to appoint can only be moved by the Prime Minister with the agreement of the chair of the House of Commons Public Accounts Committee, which is always an Opposition MP. Other than for parliamentary bodies, the greatest power lies with the House of Commons Treasury Select Committee which both has to approve the appointment of the chair of the OBR and veto their dismissal. In other cases parliament’s role is limited to holding a confirmation hearing. Parliamentary arrangements can have teeth: the Government’s original preferred candidate for Chair of the UK Statistics Authority, Dame Janet Finch, withdrew her candidacy in 2011 after a pre-appointment hearing with the House of Commons Public Administration Select Committee revealed differences in how independence from Government was understood, and it seemed possible that the Committee would not confirm her appointment though a report was not published.340 For the ICAI, ministers decided the final appointment (and indeed, there was controversy that they were given an unranked choice of candidates),341 but the House of Commons International Development Committee was represented on the appointment panel.
(b)UK-wide bodies also have a responsibility to reflect devolved arrangements, and this includes for some either reporting or leadership appointment responsibilities. So the Social Mobility Commission for example includes at least one commissioner each from Northern Ireland, Scotland and Wales. While no safeguard against political interference per se, this is another informal block against a body becoming dominated by the Government at Westminster. In such cases the devolved administrations will usually need to agree to chair appointments.
Finally, while independence is important, effective governance is vital for ensuring the body itself acts properly, and maintains focus on its core role. Independent organisations can be the greatest danger to their own independence by acting improperly, and appearing to be unaccountable. The Audit Commission in hindsight had overreached itself while alienating those who would have supported it, reversing a previous record of good engagement with local councils and minister.342 While independence is aided by leaders feeling secure enough in their positions to defy ministers when required, it is important that there are mechanisms for replacing leadership when needed—which is why the Comptroller and Auditor General is now subject to a ten year non-renewable term limit, a change introduced after the previous post-holder, who had been in post for nearly thirty years.
What bodies need to operate
My analysis suggests that as well as the form and safeguards needed to ensure independence, bodies require the following to operate effectively:
(a)A right of access to information is vital for bodies to do their job. Some of the bodies considered do gather information from those they monitor or regulate which can be used for broader interpretive analysis, as with HEFCE and EFA for sectoral insight, or the NPIA drawing on police data. But a right of access is crucial for those who do not gather the information they require themselves. The DDRB is dependent on bodies submitting evidence to it, such as the BMA and Department for Health. Some have this right in law: for example, the OBR has a statutory right to all Government information required to fulfil its duties.
(b)The right staff is required for the body to do its job. In most cases this consists of a secretariat plus analytical capacity—the latter needs to be of sufficient calibre and capacity to produce robust material. This can be in-house—as it is with the UKSA which has the ONS as its executive office, and the OBR—or contracted, as with the ICAI. Other models include the DDRB which, alongside the other pay review bodies, is serviced by analysts in the Office for Manpower Economics, and hybrid models which combine their own analytical capacity with contracting specific pieces of analysis, which the LPC does. Indeed, the LPC began with very cautious wage increases in the late 1990s because it discovered the evidence around labour market effects was limited: its commissioning of research since has hugely strengthened this evidence base. Some of these bodies which take on additional functions become very large, especially those with delivery, regulatory and inspection functions like the EFA, HEFCE and the Audit Commission. But those with a tightly defined remit have small dedicated resource: the LPC has nine commissioners and a secretariat of eight, and spent £244,000 on commissioned research in 2015. The point is not the size, but the appropriateness of resource to fulfil its role effectively—and for this resource to be guaranteed.
(c)Effective leadership is essential, especially chairs for larger bodies to establish them as independent entities, especially in the media, as has happened with the OBR in recent years. This does not always entail appointing ‘big beasts’—the credibility of the LPC depends on effective consensus among the commissioners—so experience of effective chairing rather than representation is the key skill required.
Implications for a new, independent health and social care body
Establishing a new body on health and social care has been the subject of much discussion recently, including in written and oral evidence given to the Committee by figures including Jennifer Dixon from the Health Foundation and Robert Chote from the OBR. Spokespeople from the Labour, Liberal Democrat and Scottish National parties supported some form of independent body to give periodic reports on health and social care funding.343 The Labour party recently reiterated its support for such a body to report on the level of funding required by the NHS.344 Think tanks including The King’s Fund and Health Foundation have also suggested a case for an independent body to advise on health and social care resourcing.345 Think tanks have also mooted other possible roles for an independent body, such as the SMF suggestion of an OBR-style Office for Patient Outcomes to increase accountability for patient outcomes.346
The remit of any new body would need to be carefully considered and clearly agreed. As my analysis indicates, clarity on scope and purpose is critical to a body’s potential effectiveness. For a new health body, choices would likely need to include what functions it will perform, for example analytical, advisory, monitoring—or indeed if it would exercise any executive or decision-making function, which is rare for independent bodies. The remit would need to be clearly and widely understood, and would need to fit within the wider landscape of existing health bodies—potentially therefore entailing further changes in the system.
A new body set up to provide an independent and impartial overview of Government policy relating to health and social care is unlikely to be able to adopt wholesale an existing model, such as the OBR, which is most often cited as an example of an effective, influential body some would like emulated in the health and social care sector. However, from considering comparable independent bodies which perform a range of functions, there are key implications for the composition and reporting arrangements of any new independent health body.
First, in terms of the composition of a new body, the key decisions relate to the resource it requires to fulfil its role, and its leadership.
Resource
Bodies I looked at either add new or expert insight (e.g. NICE) or are intended to bring together stakeholders and data to establish consensus positions on controversial issues like the minimum wage level or doctor’s pay rates. Would a new body be intended primarily to conduct expert analysis currently missing, or solve a problem of current unresolvable politics or misaligned incentives?
If a body is to undertake its own analysis to inform health and social care decision making, it would need a sufficiently well-resourced analytical capacity—and/or a research budget to commission additional work—in order to do this. The OBR has a budget of £2.6m and staff of 27 civil servants, which is slightly less than the Committee on Climate Change which is a similarly analytically-heavy body but with a relatively narrow remit.
Leadership
A new body would require effective leadership, of at least a Chair and likely a number of Commissioners too (the comparators started at a minimum of two additional Commisioners) with requisite expertise and credibility to establish the body, build strong relationships with powerful stakeholders—including NHS England, and the Department for Health—and ensure its independence.
Permanence
Is the problem the body is set up to resolve a temporary or permanent one? One option would be to set up a temporary commission—similar to previous attempts to establish consensus on the way forward, such as the Wanless Review—to devise, set out and agree a course of action on health and social care, but then to establish a small, focused independent body to monitor its delivery—for example, of spending against a level of GDP—and act akin to those bodies I looked at which have advisory and monitoring functions, such as the CCC.
Second, my analysis suggested there would be four key decisions to take on reporting arrangements:
Frequency
Most bodies I looked at with a regular reporting rhythm did so annually, such as the LPC and SMC. This includes financial bodies like the EFA and HEFCE.
Initiation
Independent bodies with a similar remit to that which has been proposed for a new body on health and social care usually report on a regular basis, typically annually or alongside an existing timetable, as the OBR does with fiscal events. This should be set out clearly when the body is established. Beyond that, it should also be determined whether ministers, NHS England, or indeed anyone else should be able to request or commission additional analytical work and, if so, under what circumstances. There are good reasons for allowing this, particularly in an area where independent, evidence-based analysis is required. But the process for it should be clear.
If the body is to be given a role which includes a monitoring or inspection function, it should not only be clear that it can initiate this work itself but that the power of ministers to circumscribe it—for example, by denying necessary information—are limited.
Time horizon
If the body is to contribute analysis to, or even have a more direct role in determining future funding of health and social care, there is a choice about how long-term it should report on, for example, whether it should report on future demand.
Purpose
Advisory bodies typically report to ministers, but publish and/or lay before parliament their final reports, including the MAC and NIC. However, others have been deliberately structured to feed into parliamentary scrutiny, most recently the ICAI. This is perhaps most appropriate when, like the ICAI, a body is itself evaluating Government performance and making recommendations. If a body exists to provide independent analysis, then a reporting line more like the MAC, LPC and so on may be more appropriate.
In any case, it should be clear what is expected to happen because of a body’s reports: to inform ministerial decisions, to determine a course of action, to report against a target or standard to enable parliamentary and/or public accountability, and so on.
Emma Norris, Specialist Adviser
12 January 2017
314 N. Timmins and T. Gash, Institute for Government, Dying to Improve: The Demise of the Audit Commission and Other Improvement Agencies (March 2014): https://www.instituteforgovernment.org.uk/sites/default/files/publications/Dying%20to%20Improve%20-%20web.pdf [accessed 28 March 2017] and BBC News Online, ‘Eric Pickles announces plans to scrap Audit Commission’: http://www.bbc.co.uk/news/uk-politics-10970008 [accessed 28 March 2017]
315 ICAI, Framework Agreement: http://icai.independent.gov.uk/wp-content/uploads/ICAI-DFID-Framework-Agreement.pdf [accessed 28 March 2017]
316 HM Treasury and National Infrastructure Commission, Remit Letter to the NIC (23 November 2016) :https://www.gov.uk/government/publications/remit-letter-to-the-national-infrastructure-commission [accessed 28 March 2017]
317 Department of Health, DDRB & Office of Manpower Economics, DDRB remit letter from the Department of Health: 2017 to 2018 (31 August 2016), https://www.gov.uk/government/publications/ddrb-remit-letter-from-the-department-of-health-2017-to-2018 [accessed 28 March 2017]
318 HM Treasury, Letter from the Chief Secretary to the Treasury to Pay Review Body chairs (25 August 2015): https://www.gov.uk/government/publications/letter-from-chief-secretary-to-the-treasury-to-pay-review-body-chairs [accessed 28 March 2017]
319 The Labour Party, The Armitt Review: An independent review of long term infrastructure planning commissioned for Labour’s policy review (September 2013): http://www.policyforum.labour.org.uk/uploads/editor/files/The_Armitt_Review_Final_Report.pdf [accessed 28 March 2017]
320 Infrastructure Planning Commission, National Infrastructure: A planning system fit for the 21st century; Infrastructure Planning Commission end of period report October 2009–March 2010 ( 26 July 2010): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/247711/0165.pdf [accessed 28 March 2017]
321 Infrastructure Planning Commission, Infrastructure Planning Commission (26 July 2010): https://www.gov.uk/government/organisations/infrastructure-planning-commission [accessed 28 March 2017]
322 DDRB and Office of Manpower Economics, Contract reform for consultants and doctors and dentists in training – supporting healthcare services seven days a week (16 July 2015) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445742/50576_DDRB_report_2015_WEB_book.pdf [accessed 28 March 2017]
323 Institute for Government, ‘Ministers reflect: Andrew Mitchell’: https://www.instituteforgovernment.org.uk/ministers-reflect/person/andrew-mitchell/ [accessed 28 March 2017]
324 BBC News, ‘UK government axes its sustainability watchdog’: http://www.bbc.co.uk/news/science-environment-10725394 [accessed 28 March 2017]
325 NICE, ‘Get involved’: https://www.nice.org.uk/get-involved [accessed 28 March 2017]
326 NIC, National Infrastructure Assessment Call for Evidence (27 October 2016): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/563516/NIA_call_for_evidence_October_2017.pdf) [accessed 28 March 2017]
327 Tom Gash et al., Institute for Government, Read Before Burning (July 2010): https://www.instituteforgovernment.org.uk/sites/default/files/publications/Read%20before%20burning.pdf [accessed 28 March 2017]
328 Cabinet Office, Public Bodies Handbook – Part 1: Classification of Public Bodies, Guidance for Departments: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/519571/Classification-of-Public_Bodies-Guidance-for-Departments.pdf [accessed 28 March 2017]
329 An attempt in the 2010 Public Bodies Reform Bill to provide for ministers to abolish bodies named in a schedule by secondary legislation proved highly contentious and ministers had to withdraw the proposed provision; for instance see HL Deb, 23 November 2010, cols 1010–1046
330 ‘Chancellor Philip Hammond slammed over misleading claims over National Infrastructure Commission ‘independence’’, The Independent (13 October 2016): http://www.independent.co.uk/news/business/news/government-slammed-over-national-infrastructure-commission-independence-claims-a7359956.html [accessed 28 March 2017]
331 OBR, Letter to Chairman of the Treasury Select Committee (15 January 2014): http://budgetresponsibility.org.uk/docs/dlm_uploads/TSC_pre_election_costings.pdf [accessed 28 March 2017]
332 Institute for Government, ‘Ministers reflect, Andrew Mitchell’: //www.instituteforgovernment.org.uk/ministers-reflect/wp-content/uploads/2015/11/Andrew-Mitchell [accessed 28 March 2017]
334 For a full discussion of the demise of both the Audit Commission and National Police Improvement Agency, see N. Timmins and T. Gash, Institute for Government, Dying to Improve: The Demise of the Institute for Government, Audit Commission and Other Improvement Agencies (March 2014): https://www.instituteforgovernment.org.uk/sites/default/files/publications/Dying%20to%20Improve%20-%20web.pdf [accessed 28 March 2017]
335 Ed Balls, Speaking Out: lessons in Life and politics (London: Hutchinson, 2016), pp 150–151
336 DDRB and Office of Manpower Economics, Contract reform for consultants and doctors and dentists in training – supporting healthcare services seven days a week (16 July 2015): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445742/50576_DDRB_report_2015_WEB_book.pdf [accessed 28 March 2017]
337 Migration Advisory Committee, Review of Tier 2 report: balancing migrant selectivity, investment in skills and impacts on UK productivity and competitiveness (19 January 2016): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/493039/Tier_2_Report_Review_Version_for_Publishing_FINAL.pdf [accessed 28 March 2017]
338 Jill Rutter et al., Institute for Government in partnership with the Public Chairs Forum, It Takes Two (March 2012): https://www.instituteforgovernment.org.uk/sites/default/files/publications/it_takes_two_final_0.pdf [accessed 28 March 2017]
339 For a fuller discussion of the potential role for parliament in public appointments see A. Paun and D. Atkinson, Institute for Government, Balancing Act: the right role for parliament in public appointments (March 2011): https://www.instituteforgovernment.org.uk/sites/default/files/publications/Balancing%20Act.pdf [accessed 28 March 2017]
340 Public Administration Select Committee, Appointment of the Chair of the UK Statistics Authority (Sixteenth Report, Session 2010–12, HC 910–1)
341 ‘Dr Alison Evans to head Britain’s independent aid watchdog’, The Independent (11 December 2014): https://www.theguardian.com/global-development/2014/dec/11/dr-alison-evans-icai-head-britain-independent-commission-aid-impact-watchdog [accessed 28 March 2017]
342 Nicholas Timmins and Tom Gash, Institute for Government, Dying to Improve: The Demise of the Audit Commission and Other Improvement Agencies (March 2014): https://www.instituteforgovernment.org.uk/sites/default/files/publications/Dying%20to%20Improve%20-%20web.pdf [accessed 28 March 2017]
344 ‘Labour calls for OBR-style watchdog to assess NHS finances’, The Guardian (27 December 2016): https://www.theguardian.com/politics/2016/dec/27/labour-calls-for-obr-style-watchdog-to-assess-nhs-finances [accessed 28 March 2017]
345 Ibid.
346 Social Market Foundation, E. Mian, An Office for Patient Outcomes (April 2016): http://www.smf.co.uk/wp-content/uploads/2016/04/Social-Market-Foundation-An-Office-for-Patient-Outcomes-Embargoed-0001–050416.pdf [accessed 28 March 2017]