Geoff's blog

Wouldn’t it be NICE?

Geoff Mulgan - 07.06.2012

A few years ago, I and others started promoting the idea of creating a NICE for areas of public policy. NICE is the National Institute for Health and Clinical Excellence and is a unique institution that publicly rules on what works in healthcare - and what's cost effective.

Its findings aren't always acted on; and it's often controversial.  But it has a great deal of authority and does have a direct influence on practice, providing  an open and transparent pressure for doctors and hospitals to do things with the best prospect of achieving results, rather than what they've always done.  One of the many fascinating features of NICE, for example, is that it's often shown that simple public health interventions - like smoking cessation programmes - are far more cost effective than drugs or specialised treatments. 

NICE has a budget of £60million and 250 staff, so couldn't be easily replicated. But when we floated the idea of copying it back in 2008 and 2009 we quickly found interest, for example from various parliamentary select committees.  The field of criminal justice looked like a particularly promising one - given the endless controversies over whether prison works, or the relative effectiveness of different kinds of rehabilitation, and various Young Foundation reports set out how a NICE could work there.   We also did advisory work for the Australian government and scoped out how NICE-like bodies could work in the fields of schooling and welfare services.  In the US, a series of events and reports with the Center for American Progress pushed variants of the idea (and the US is now creating a variant of NICE).

Our problem was that although there was interest in general, it proved hard to turn that into action.  Governments are quite wary of the constraints that follow from making evidence visible - for the fairly obvious reason that it may show that their cherished policies don't work.  Academics can also be ambivalent about new bodies that created more standardised, and sometimes demanding, standards for evidence.  And at a time of spending cuts it looked like evidence would be seen as a luxury that no one could afford.

But now there does seem to be some real momentum behind the idea. The Alliance for Useful Evidence which Nesta has set up with the ESRC and Big Lottery Fund is moving into full scale action, and has brought together hundreds of organisations with a shared commitment both to improving the usefulness of evidence, and to ensuring that it really is used.  The forthcoming civil service white paper may commit to supporting a NICE for social policy. The new endowment funds supported by the government look set to play important NICE-like roles, and the Education Endowment Fund has made a flying start.

Very quickly the idea has moved from the margins to the mainstream.  There are many ways to make new kinds of NICEs happen, from setting up a highly centralised organisation to bringing together loose networks, as well as hybrids with elements of both.  There are also many different ways new NICEs could work, for example focusing on policy, or programmes or practice (NICE doesn't ever look at policies - and it's intriguing to ponder what might have happened to NHS reform if it did). 

This week a new report prepared by Nesta's Ruth Puttick looks at some of these options, building on previous reports published last year.  The good news is that this an idea whose time might be coming.  Keynes famously said that there is nothing governments like less than being well informed because it makes the process of decision making much too difficult. But for once the cynics are being proven wrong.