Arm’s length bodies in the COVID-19 response
Reported by Nick Cosstick, Policy Researcher at CSaP
The role of health focused ‘arm’s length bodies’ (ALBs) is an important policy issue, especially in light of the COVID-19 pandemic. ALBs are public sector bodies which have a degree of autonomy from ministerial control, such as the Care Quality Commission and the NHS Business Services Authority. A new research project from the Institute for Government explores how these bodies and their relationships to central government shaped the response to COVID-19.
On 10 November 2021, the Centre for Science and Policy hosted a seminar on how ALBs were used in the COVID-19 response, as part of its Policy Fellow series on the government’s use of data, science, and evidence. Speakers Matthew Gill and Grant Dalton, from the Institute for Government, outlined their research on the interface between health focused ALBs and central government during the pandemic. Their particular interest is in the early lessons that might be drawn for future crises.
Their research used particular ALBs as case studies: the Medicines and Healthcare products Regulatory Agency (MHRA), NHS England and Improvement, and Public Health England. It incorporated desk-based research and interviews with people in relevant areas of central and arm’s length government.
Flexing under pressure
A main area of investigation concerned the way in which the governance of the ALBs had to flex under pressure during the pandemic. Gill and Dalton said they found that central government tended to bring “high-profile decisions” under its control. For example, key decisions on social distancing were taken centrally. There was also a need for experts within ALBs to speak directly with ministers and civil servants. When policy is rapidly evolving, this might include circumventing the pre-existing governance structure––which would have required health focused ALBs to communicate with central government via the Department for Health and Social Care.
Gill and Dalton argued that the constitutions, or framework documents, which apply to health focused ALBs––such as the NHS England framework document––may not adequately describe how decisions are made during crises. They said ministers’ views regarding ALBs’ credibility and trustworthiness can matter more than the level of independence granted in normal times. Gill and Dalton also recommended that “ministers should resist the temptation to tighten control” over ALBs generally, merely because they required control during crisis conditions. Instead, the role of central departments and Number 10 in the governance of ALBs should be clarified, to avoid tension and friction between government institutions in future crises.
Responding at pace
Another area of investigation concerned how the pre-existing relationships between the ALBs and central government affected their ability to respond at pace to the challenges of the pandemic. Gill and Dalton found that “the information needed to make decisions may not be readily to hand” among decision-makers in central government. For example, they said the NHS Test and Trace was criticised for “not sufficiently leveraging local capability” because the key decision-makers in central government understandably did not have a deep knowledge of the local capacity that existed. Gill and Dalton recommended that decision-makers in central government should not look to set up new structures to deal with the challenges posed by crises. Rather, they should rigorously explore the capabilities of the different ALBs and other parts of government, and how they can be utilised to deliver key objectives. This requires establishing and nurturing relationships with key people in ALBs before crises occur.
The use of external expertise
The final area of investigation concerned how expertise from outside of central government was brought to bear on emergency policy decisions during the pandemic. It was argued that ALBs typically have more specific expertise than is found in central government. For example, ALBs’ expertise is often built around technical tasks, such as regulation. Therefore, ALBs provide a particularly rich source of knowledge in government.
Gill and Dalton’s first key judgment on external expertise concerned the distinction between ‘advice’ and ‘decision-making’. Ministers’ talk of ‘following the science’ has been viewed as shirking their responsibility as decision-makers. Furthermore, there was initially an expectation within the government advisory group SAGE that ministers should ask very clear and rigid questions and then wait for answers. This was not well-matched to the fast-paced decision-making that ministers faced. According to Gill and Dalton, a solution to these issues is to “make experts more aware of the policy context for their guidance, and more able to understand why they’re being asked for that advice and what it’s going to be used for”.
Their second key judgment on external expertise concerned the importance of the public credibility of ALBs. Their research indicates that ministers are much more likely to listen to the private advice of a body with a good public reputation. For example, MHRA leveraged their positive public reputation to push back on the government’s plan for mass daily COVID-19 testing in English schools. According to Gill and Dalton, the perceived independence of MHRA also led to “an increased public trust in vaccines”. By contrast, Public Health England’s pre-established reputation for lacking independence and a public voice meant their experts found it harder to express positions inconsistent with government policy. Therefore, they recommended that ALBs should establish public trust and, “express their views of the facts and their expert opinions, even if these are inconvenient to the government, where necessary”.