What are think tanks for?

As I prepare to leave the Nuffield Trust after seven years, I’ve been reflecting on the many things I have learned in that time. Although I had read countless reports emerging from think tanks in my 25 years working in the NHS, when I joined the Trust, I would have been hard pushed to articulate clearly what think tanks were for and how they went about doing it. But I did think they would be interesting places to be. If I may be allowed to offer one piece of career advice, if you’re ever offered a role where, although you’re not 100% sure what you’re going to be doing, the people are interesting and you’ll have an opportunity both to shape the role and to learn, grab it with both hands. I did, and I have not regretted it once.

Now, although if you’ve seen one think tank you’ve seen one think tank, there are some common characteristics. So based on my experience of the last seven years, here are three things politically neutral think tanks like the Nuffield Trust do. And one thing they don’t do.

Think tanks hold the mirror up

Think tanks use evidence, both quantitative and qualitative, to show how the world is, not how we would like it to be. And sometimes, how that world has changed over time – for example, the Nuffield Trust and King’s Fund sponsor the British Social Attitudes Survey that has been running for 40 years. They can speak truth to power and highlight where power imbalances have consequences. They evaluate what works, what doesn’t work, and why. Of course, some things can be open to interpretation and some results will be different if different assumptions and methodologies are applied. So where that’s the case, they will say so – a topical case in point being the relationship between pay and inflation for doctors in England.

Think tanks are sensemakers

We find ourselves in a complicated and complex world. Think tanks can help to bring order to the apparent chaos. Through explainers and trackers they can ensure that key facts – in our case about health and care – are easily accessible not only to people within the service, but also to the wider public, including via the media. For instance, the Nuffield Trust produces three regular trackers, on finance, workforce and performance, and has published a number of explainers like this one on community services.

Think tanks also spend quite a lot of time debunking myths (including sometimes myths believed by people working in the system). For example, is the NHS being privatised, or the way in which strikes are affecting waiting lists.

Think tanks understand how policy-making works

Both in theory and practice. So they understand how a beautifully conceived policy intervention can be derailed by its first contact with politics (big or small p), or indeed first contact with practitioners on the ground. And they understand why kneejerk political responses tend to fail again and again, because the policy thinking hasn’t been done properly. They can also locate health and care policy (in the case of the Nuffield Trust) within wider public policy, so drawing attention to the unintended consequences of actions, to the potential winners and losers from a proposed policy, and to the external issues which will help or hinder the achievement of policy aims in health and care.

And in doing this, they can also act as a ‘bridge’ between the worlds of academic research, policy-makers, those who implement policy and those staff and service users on the receiving end of policy decisions. People in each of those worlds have different and valuable perspectives on the problems at hand, but all too often they stay firmly in their own worlds. Think tanks build connections between them. The NIHR-funded Rapid Service Evaluation Team, in which the Nuffield Trust is a partner, is a great example of that.

So having looked at some examples of what think tanks do do, I also promised to tell you one thing that think tanks like the Nuffield Trust don’t do.

Think tanks don’t think for you

There are some political think tanks whose job it is to develop and test ideas for political parties. But the purpose of neutral think tanks like the Nuffield Trust is to help people and organisations think better for themselves. Only you and your organisation or system know your particular context and set of challenges. Think tanks can help you to frame your questions well, to find and apply evidence when coming up with solutions, and to understand what might lift and shift as learning from elsewhere, as well as what might not. They can help you to evaluate the impact of your actions. In the end, they are your questions and your answers. But you will ask better questions, and come up with better answers, when you use well-presented evidence to help you.

So, I leave with a much better understanding of the work of think tanks than I had when I arrived. It’s often said, usually pejoratively, that ‘think tanks’ are not ‘do tanks’. It’s true, they’re not (except when the ‘doing’ refers to delivering high-quality research!). But one thing that has been abundantly clear to me throughout my time at the Nuffield Trust is that people who work in think tanks come to work to make a difference. The Nuffield Trust’s mission is “to improve the quality of health care in the UK”. And it really matters that, as a result of the Trust’s work, somebody somewhere does something differently and better, whether that’s a journalist presenting a story in the media more accurately, local leaders using data differently to inform their local plans, or a politician making a better strategic policy choice.

It’s been a privilege to be part of the Nuffield Trust for seven years – seven truly exceptional years in the history of health and care in this country. There are few organisations which have both the ability to stand back and look at the big picture, and to explore detail – and to make the connection between the two. And most importantly, to speak without the constraints which come from being within ‘the system’, and independently of political pressure. In these turbulent times, they are voices which can be trusted.