Spotlight on 2017 | 3

SPOTLIGHT 2017

Keeping pace with change

Introduction

One certainty of life is change policy and decision making to to be made along the path and 2017 had more than its fill. shape our future for the better. to better systems in health, Change may be sudden and At RAND Europe, we recognise policing and education. dramatic or slow and gradual. the power of change and deliver It might affect whole societies robust, relevant insights to As the certain but ever-flowing and communities or just a few harness it for the public good. pace of change continues, individuals. But what is certain RAND Europe remains is that the future impacts and This edition of Spotlight features dedicated to delivering objective implications of changes seen a selection of our work carried research and analysis to help in 2017 – whether social and out in 2017 to help meet new policy and decision makers political upheavals or new and evolving challenges. We create a future in which all can policies, technologies and have completed several studies thrive and prosper. I hope you innovations — will impact that examine the implications enjoy reading about the ways society for years to come. of Brexit for the UK, the EU, and we achieved this goal in 2017. beyond. We have examined Objective policy research and the potential of increasingly analysis plays an important advanced technology, including role in helping society keep in the areas of cybersecurity pace with change. Anticipating, and digital transactions. interrogating and understanding And we have evaluated and its effects can also help improve recommended improvements Hans Pung, President 2 |

Table of contents

4 Equipped for change 14 Arms trade on the dark web • Monitoring open science

• Tackling violent radicalisation The future of digital and extremism 18 • The implications of a ‘connected society’ • The opportunities and challenges of After Brexit: likely trade scenarios and blockchain 6 their impact on the UK, EU and US 20 International researcher mobility 8 Gaming for research • The future of Arctic cooperation in a changing strategic environment 24 Later school start times • Delivering strategic gaming for senior defence officials Why data? • Strategies for addressing 26 antimicrobial resistance • Using health data to improve health systems • Using ambulance data to help 11 Exploring cybersecurity challenges fight violent crime • Reforming NATO’s cyber acquisition process What British people want from • Working with the EDA on European 28 Brexit cyber defence priorities • Countering cybersecurity threats to the 2020 Tokyo Olympics Spotlight on 2017 | 3

32 Mind matters 40 Looking back to plan ahead • Healthy workplaces • Researcher mental health 42 Events in 2017

Policy Research in Science and Council of Advisors 35 Medicine 44

Clients and collaborators 36 Healthcare solutions 46 • The future of health • The ‘telephone first’ approach 48 Areas of expertise

Teacher shortages in 38 Cambridgeshire 4 | Equipped for change

Targeted research tools have the power to transform our understanding of complex policy issues. In 2017, RAND Europe equipped policy makers with useful new tools in two very different fields.

Monitoring open science

Open science aims to create policy areas for research, is hosted by the European greater transparency in research science and innovation. In this Commission Directorate-General by removing barriers to sharing emerging area there is, however, for Research and Innovation outputs, resources, methods and a lack of information about open and supports the Open Science tools. The aim is that anyone, science practices to inform Policy Platform to facilitate from researchers to the general policy making. structured discussion between public, can access and exchange stakeholders. By providing policy scientific knowledge at any stage RAND Europe and partners were makers and others with access of the research process. asked to develop a monitor to open science data and trends, to provide an evidence base the monitor supports initiatives Open science is now firmly on that tracks worldwide trends across Europe and informs Europe’s policy agenda. In 2015, in open science and identifies policy making to increase the the European Commission the main drivers and barriers exchange of scientific knowledge named it one of three priority to its evolution. The monitor worldwide. Spotlight on 2017 | 5 Equipped for change

Tackling violent radicalisation and extremism

With terrorist activity increasing were simply not known. No around the world, and new standardised methodology forms of terrorism emerging, existed to identify practices, there is an urgent need to and the knowledge and capacity understand the effectiveness to perform robust evaluations of current strategies countering was also lacking. violent extremism. Our researchers developed an The European Union and online evaluation toolkit that There is no individual member states have helps stakeholders objectively invested heavily in policies, assess different interventions point in waiting programmes and interventions using the most appropriate and until the tidal wave to prevent and tackle violent scientifically robust methods. It radicalisation and extremism. can be used by any stakeholder of radicalisation There is still, however, only in the field, from government is over to reflect limited knowledge of what policy makers to frontline upon the outcome works best in this field. workers in NGOs, social work and law enforcement. of our efforts to To advance understanding, combat it RAND Europe led 14 partner The IMPACT Europe toolkit also organisations in establishing provides a database of practices the IMPACT Europe project. in the counter violent extremism Over three and a half years, field, and lessons learned from the project sought to analyse previous evaluations. The hope what works in preventing and is that rigorous evaluation of tackling violent radicalisation policies and programmes will and extremism. become the norm, enabling new strategies that get the The project revealed that the best results for individuals most promising practices and society. Jacopo Bellasio managed for tackling these issues the IMPACT Europe project 6 |

Likely trade scenarios and their impact on the UK, EU and US

The success of Brexit depends of open trading and investment 5 per cent after ten years, a loss to some degree on its economic relationship post-Brexit. Failure of £109 billion. impact. A range of possible to achieve any such relationship trade opportunities and is likely to have negative The EU would also be likely to arrangements could be agreed implications for both the UK and lose out from trading under between the UK and the EU, the EU, and provide little, if any, WTO rules, but not to the same and with other countries, such gain for the US. In particular, the extent as the UK. The economic as the US. UK is likely to be economically loss to the EU could be about worse off outside the EU under 0.7 per cent of its overall GDP, Using an economic model, we most plausible trade scenarios. or about £76 billion. analysed the implications of eight different trade scenarios Of the eight scenarios analysed, The seven other trade scenarios involving the UK, EU and US the worst option for the UK appear to be considerably better after Brexit. The study revealed would be to leave the EU with for the UK than trading under that it would be in the best no deal and simply apply World WTO rules. However, most interests of the UK, and to Trade Organization (WTO) rules. options would probably still lead some extent the EU, to work This scenario could reduce the to economic losses compared together to achieve some form UK’s future GDP by around with its current status as an Spotlight on 2017 | 7

For the US, the economic THE EIGHT DIFFERENT TRADE effects of most trade scenarios SCENARIOS WERE A MIX OF ‘HARD’ AND ‘SOFT’ BREXIT appear negligible, apart from the SCENARIOS: trilateral UK–EU–US agreement. The political and security ‘HARD’ BREXIT effects of Brexit are likely to An arrangement in be of greater significance to which UK trade is the US, which will miss the governed by WTO rules Trading under influence that the UK brings to the EU decision-making process, The successful WTO rules could particularly around foreign negotiation of a UK–EU policy, security and defence. free trade agreement reduce the UK’s (FTA) future GDP by The study also used game The creation of a theory insights to create a UK–EU–US FTA based around 5% after better understanding of how on the proposed 10 years, a loss of a wide variety of factors Transatlantic Trade might affect the outcome of and Investment Partnership (TTIP) the Brexit negotiations and influence trade talks between The creation of a £109bn the UK and EU. Our insights US–UK FTA excluding suggest that the EU is likely to the EU cooperate with the UK to reach EU member – even ‘soft Brexit’ an arrangement that suits both An extended transition period during which EU scenarios, such as the Norway parties. However, it may see and UK tariffs do not option of Single Market access. benefit in adopting a ‘zero- change but other non- sum game’ approach as a way tariff barriers to trade The only scenario examined to discourage other member come into effect likely to have a positive states from withdrawing, which economic benefit would be a we assessed to be the EU’s top trilateral agreement between political priority. ‘SOFT’ BREXIT the UK, EU and US, similar to the The Norwegian model shelved Transatlantic Trade and For the UK, our findings show (membership of the Investment Partnership (TTIP) clearly that negotiators should European Economic agreement. This option would seek ways to move towards a Area) leave the UK 7.1 percentage ‘positive-sum game’ as talks points of GDP better off than the proceed. This will help to ensure The Swiss model WTO rules scenario: a slightly the best possible deal for all (a series of bilateral better outcome than continued parties. A UK strategy of trying agreements) EU membership. However, this to pick apart European unity is arrangement is seen as very unlikely to work since it is in the unlikely in the current political best interests of all EU member A customs union environment. states to work together. 8 | GAMING for research

RAND Europe’s use of gaming techniques allows decision makers to consider complex problems in a simulated environment as a test bed for different policy options. Participants are able to think creatively about ways to tackle issues and gain different perspectives on the cross-sector consequences of decisions. The most traditional version of gaming, well known to the defence sector, is the military board game, used to test the possible effects of decisions made in times of conflict. Gaming comes in many forms, however, and can be applied to many sectors. In 2017 RAND Europe used bespoke games in a variety of situations to create a better understanding of how a range of factors might affect outcomes. Spotlight on 2017 | 9

The future of Arctic cooperation in a changing strategic environment

The Arctic has become an area shipping and oil industries, with increased potential for indigenous communities and conflict among nations due security research institutions. to its rich natural resources, The participants were presented maritime activity and other with plausible starting factors. While cooperation in conditions for the year 2020 and the region remains strong for asked to consider courses of now, RAND Europe conducted action and possible reactions a tabletop gaming exercise as various events transpired. to examine the factors that The game helped generate could potentially upset insights about the strength of cooperation over the 2020 cooperation, potential triggers WHAT IS GAMING? decade. Attendees included for tensions and the advantages participants from the Arctic and shortcomings of potential In conflict situations, the nations, including diplomatic policy options in the Arctic. choices made by decision and defence organisations, makers are crucial. Yet complex situations typically have multiple dimensions that should Delivering strategic gaming be considered well before decisions are made. for senior defence officials So how can decision makers evaluate their 2017 was the first of three groups as designated countries options for scenarios that academic years in which to generate national security have not yet happened? RAND Europe has been asked strategies, decide courses of Gaming, an established to design and deliver the action, brief officials, conduct research methodology, strategic gaming component negotiations and handle the brings people together to of the UK Royal College of press. In addition to building consider what steps might Defence Studies’ (RCDS) one- knowledge of strategic-level be taken in hypothetical year Strategic Studies Course decision making, the strategy situations rooted in the for senior defence officials exercises help strengthen real world. By interacting from around the world. Each bonds between RCDS course with people from a range strategy exercise involves all members, many of whom of domains, participants 110 RCDS course members will become future Chiefs of can gain wider facing a number of hypothetical Defence or hold other senior perspectives and explore international crises in near roles in their respective the possible ramifications real time. Participants play in countries. of their decisions. 10 | Gaming for research

Strategies for addressing antimicrobial resistance

In 2017 RAND Europe pushed to discuss the potential and the UK’s Chief Veterinary the boundaries of gaming consequences of different Officer, Professor Nigel Gibbens. applications to the health policy actions through plausible Participants were encouraged to sector in an innovative way. future scenarios. consider different approaches Antimicrobial resistance to address the rise in resistance (AMR) is an incredibly complex The game reached a high-level to antibiotics. The insights policy issue, affecting human audience of policy makers, gained during the game were health, animal health and the practitioners, funders and used to inform policy decisions environment. We developed and academics, including the Chief regarding what to include in the led a resource allocation game Medical Officer for England, UK’s revision of its current AMR to encourage stakeholders Professor Dame Sally Davies, strategy.

The RAND gaming event used real-life scenarios to stimulate and engage a wide range of stakeholders across the UK and provided a fresh way of looking at AMR – views were challenged, new ideas formulated, and areas for further work were identified. I am grateful for the support of RAND in helping us to identify new ways to think about the complex issue of AMR both at home and abroad.

Professor Dame Sally Davies, Chief Medical Officer, England

Jenny Oberholtzer and Jirka Taylor at the AMR game Spotlight on 2017 | 11

EXPLORING CYBERSECURITY CHALLENGES

Governments and other organisations worldwide are increasingly concerned about the threat of cyberattacks, such as the May 2017 ransomware attack that disrupted the systems of many NHS trusts. Most are now taking measures to keep cyberspace open, safe, secure and resilient. However, cybersecurity poses a range of technical, organisational and strategic security challenges. Our cybersecurity research covers many different areas, from providing strategic advice on threats and challenges to strengthening cyber defence capabilities. In 2017 our work included high-profile projects with NATO and the European Defence Agency (EDA) and explored the potential cybersecurity threats to the 2020 Tokyo Olympics. 12 | Exploring cybersecurity challenges

Reforming NATO’s cyber acquisition process

NATO sought RAND Europe’s industry engagement and support to help define the investing in people, knowledge strategic challenges it faces in and skills. developing its cyber capability and adjusting its acquisition NATO is using the processes. We identified a recommendations as a number of issues, including reference point for organisation- access to funding and the wide cyber reform, which will also need to be aligned 67% organisational culture and structure of NATO. with other NATO defence of organisations capabilities. Our report was report insufficient Our recommendations focused briefed to NATO’s Deputy on developing appropriate Secretary General and other key funds to defend cyber policies and strategies, NATO stakeholders. themselves against encouraging innovation and cyberattacks

Working with the EDA on European cyber defence priorities

Throughout 2017, RAND study examining options for and its potential added value Europe worked with the EDA on establishing a European Cyber to European cyber defence. numerous defence and security Defence Training Centre for Following the conclusion of the research projects. Common Security and Defence study, the training centre is now Policy operations and missions. being set up within the European In relation to cyber defence, Our researchers assessed the Security and Defence College. we conducted a feasibility prospects of such a centre

As cybersecurity threats continue to evolve at a rapid pace, governments, institutions and organisations need to fully understand the operational and strategic effects of technological developments

Erik Silfversten specialises in cybersecurity and cyber defence research. Spotlight on 2017 | 13

Countering cybersecurity threats to the 2020 Tokyo Olympics

Japan has been planning for RAND Europe analysed potential Two further cybersecurity threats the security of the 2020 Tokyo cyber threats to the Summer and also stood out as particularly Olympics by establishing Paralympic games and made relevant to the 2020 Tokyo security measures to protect recommendations to strengthen Olympics: global ransomware critical national infrastructure, cybersecurity. We assessed and cyber propaganda. Both improve cyber defences, and foreign intelligence services emerged as prominent security protect tourists and participants. to be the most significant threats in 2017 and have the Concerns have been voiced, cybersecurity threat, closely potential to seriously disrupt the however, about Japan’s followed by cyberterrorists Games. preparedness to deal with a and cybercriminals involved in large-scale cyber incident. organised crime.

THREAT ACTORS TO THE 2020 TOKYO OLYMPICS

Foreign intelligence Cyberterrorists services

Cybercriminals Hacktivists

Insider threats Ticket scalpers 14 |

Arms trade on the dark web

In July 2016, an 18-year-old (although foiled) attack boasted free from surveillance, to used a Glock 17 handgun that acquiring his pistol on download illegal content or purchased on the ‘dark web’ to the dark web was as easy as purchase illegal goods. kill nine people and injure 36 ‘buying a chocolate bar’. others in Germany. The incident Our study with the University cemented widespread public The dark web is an unsearchable of Manchester is the first piece concern that the dark web is portion of the internet that of research to explore the size an enabler for terrorists and requires special software and scope of the illicit trade criminals seeking firearms. packages to navigate. Users of firearms, explosives and The perpetrator of a similar can access it anonymously, ammunition on the dark web. Spotlight on 2017 | 15

Over a single week in September most common product offered 2016, we collected primary among the arms-related listings data around the sale of arms- on the dark web, followed by related products on dark-web digital products (27 per cent). cryptomarkets. We found that The latter include tutorial guides the dark web is an enabler for for a wide range of illegal trading illegal weapons already actions, such as making home- on the black market, and a made guns and explosives, as potential source of diversion well as models for 3D printing of 60% for legally owned weapons. It fully functional firearms. also increases the availability of the firearms of newer, better-performing Almost 60 per cent of firearms listings on the firearms for prices comparable listings on the dark web are to older weapons sold on the associated with products that dark web were offline black market. originate from the US, followed by Europe which accounts for for products Our analysis showed that roughly 25 per cent of listings. originating firearms (42 per cent) are the However, Europe represents the from the US

Location of the dark web

Clear web

Entry points

Deep web

Cryptomarkets Dark web 16 | Arms trade on the dark web

Worldwide distribution of arms vendors by region

EUROPE (NON-SCHENGEN)

59.9% 1.5% 23.6% ASIA

EUROPE NORTH (SCHENGEN) 0 AMERICA

0 WORLDWIDE SOUTH-EAST / UNKNOWN ASIA

CRAWLING 3.2% THE DARK WEB 11.3% OCEANIA To collect the data for this study, our researchers used software specifically designed to connect to largest market for arms traded it has the potential to become cryptomarkets (bypassing on the dark web, generating the platform of choice for any authentication revenues that are around five individuals (e.g. lone-wolf processes) and download times higher than the US. terrorists) or small groups (e.g. (‘crawl’) data from any gangs) to obtain weapons page associated with Based on the data analysed, we and ammunition, due to the them. After all the data estimate that the value of the anonymity it provides. is collected, the tool arms trade on cryptomarkets extracts (‘scrapes’) is around $80,000 per month. The illegal arms trade on specific information Furthermore, with 136 firearms the dark web has created from the downloaded or associated products sold new challenges for law pages. As a result, our every month, the security enforcement agencies and researchers were able implications of trade on the national governments, as it to analyse data while dark web should concern facilitates arms trafficking limiting exposure to the policy makers. on a global scale across dark web, its contents international borders. And, and users. In 2018, Given this finding, the study despite the relatively limited RAND Europe will further concluded that the dark web monetary value and volume of develop its research is unlikely to be the method weapons traded on the dark web capability by developing of choice to fuel conflicts, as compared to other products its own dark web crawler weapons are not traded at a (e.g. drugs) or firearms products and scraper. large enough scale. However, trafficked offline, the potential Spotlight on 2017 | 17

Shipping routes used for firearms listings generating sales

Origin Destination

Multiple/ Unknown

Worldwide

Europe

Germany Europe

Netherlands Germany

Australia Australia US UK

impact on internal security component, practical measures and record-keeping practices, is still significant. While new that states and other bodies can international cooperation for skills, tools and techniques use to limit the availability of tracing, and good stockpile will be required to conduct illegal arms remain important. management. investigations with a dark web These include efficient marking

The ability to arm criminals and terrorists, who can make virtually anonymous purchases, is perhaps the most dangerous aspect of the dark web

Giacomo Persi Paoli leads the terrorism, security and resilience research portfolio at RAND Europe 18 | The future of digital

Digital technology is becoming increasingly intertwined with everyday life: from schooling and education to political engagement and even financial and health management. While digitalisation offers many opportunities, there is also a crucial need to understand and mitigate the challenges it presents to society. In 2017, RAND Europe worked in partnership with the Corsham Institute on thought leadership events about the UK’s ‘connected society’. We also sought to understand the current landscape of blockchain, a new form of technology that can be used to manage digital transactions.

The implications of a ‘connected society’

Our work with the Corsham If the digital skills gap is not Participants stressed the need Institute showed that the UK addressed, then existing for greater planning to manage will need to address a variety of inequalities will increase. If the potentially adverse social challenges if it is truly to benefit proper planning for social and and economic effects of an from digital technologies. economic disruption does not increasingly digitalised society. take place, many people will The Corsham Institute and Four thought leadership be excluded from the potential RAND Europe have launched the events – digital learning, open benefits. If risks around data use Observatory for a Connected science, digital currency and and ethics are not anticipated, Society app, which hosts the civic engagement – flagged public trust will be undermined. latest data, analysis and opinion up warnings for policy makers, And if empathy and social on the subject, to help address highlighting the fact that the norms in the online world are this need. pace of technology change is not prioritised, civic engagement fast outstripping society’s ability and democracy may suffer. to manage its impact. Spotlight on 2017 | 19

The opportunities and challenges of blockchain

Blockchain acts as an opportunities, from efficiency online ledger spread over gains and cost savings to its multiple locations, recording potential to provide a clear information in digital blocks audit trail and reduce fraud. Now is the that form an encrypted digital However, as blockchain is still a time for policy chain which grows as new relatively new technology, there makers and information is added over are a multitude of significant time. Any information added challenges to contend with, industry to find out to the chain is secure and from high implementation what blockchain unchangeable, meaning costs to concerns about data could offer blockchain could potentially privacy. serve as an alternative way of storing and securing As blockchain becomes information on a large scale. more widespread, standards Our research on blockchain could help address such was commissioned by the concerns and establish British Standards Institution to a stronger consensus on understand whether developing consistent terminology to standards for the technology improve understanding of the would support its growth. technology. Standards could also help ensure that multiple Salil Gunashekar leads The analysis suggested that blockchain implementations RAND Europe’s research on blockchain offers an array of can exchange information. blockchain technology 20 |

International researcher mobility

The international mobility of understanding of researcher global research destinations for people is an important part of mobility patterns and drivers, international researchers, due to any research system. The UK with a particular focus on its reputation as a prestigious is no exception, and it benefits mobility to and from the UK. place to develop both careers from the skills and expertise of The study took on additional and networks. international researchers. importance following the UK’s decision to leave the EU. EU nationals make up a large RAND Europe was proportion of non-UK national commissioned by the Our research showed that the researchers working in the Royal Society to deepen UK is one of the most popular UK. Some 3,600 researchers Spotlight on 2017 | 21

came to the UK from other EU Professional factors, such countries between 2007 and as career development and 2013. By comparison, only 600 the research environment, UK researchers left to work featured strongly as reasons elsewhere in the EU over the why researchers moved abroad. same period. On the other hand, family and personal factors, such as having The UK has also benefited from children and/or a long-term EU research funding schemes, partner, were the main reasons such as European Research why researchers chose not to Council grants and Marie move abroad. Nearly 80 per Sklodowska-Curie actions. cent of respondents said that 80% There is a professional having children made them less likely to move between of researchers expectation that researchers agreed there is an are internationally mobile. In countries, while 60 per cent with fact, nearly 80 per cent of those long-term partners were less expectation that to be surveyed in our study agreed likely to relocate. a good researcher that to be a good researcher you Finding suitable employment you must be must be willing to move abroad. for a partner was the most internationally mobile

The impact of families and relationships on mobility

of respondents said that having a long-term 60% partner made them 79% less likely to move between countries of respondents said that Amongst those with children, family having children made reasons are cited as a reason for: them less likely to move between countries

respondents’ 92% choice to stay in the UK

Finding suitable employment for a partner respondents’ is the most frequently cited choice to barrier to mobility (except 43% move back for short-term mobility) to the UK amongst those with a partner 22 | International researcher mobility

The importance of international mobility to the UK

The UK makes up but hosts 15% of the 5% of the total students studying for 5% population of 15% masters and PhD degrees OECD countries... in OECD countries

Among EU member states, the UK has been the top 48,447 27,479 17,900 receiving country for PhD UK France Germany candidates from both within Within Europe: 15,301 Within Europe: 6,588 Within Europe: 10,000 and outside the EU: Outside Europe: 33,146 Outside Europe: 20,891 Outside Europe: 7,900

The number of international students studying in UK research degree programmes tripled from 1994/95 to 2012/13

During FP7 (2007−2013), the UK was the most popular Outﬂow of UK destination for the European MCSA programme, which researchers to supports researchers’ career development elsewhere in EU: 600

The UK leads the EU in the number of prestigious ERC grants it hosts. In 2016: Inﬂow of researchers from elsewhere in EU 117 grants were awarded to to UK: 3,600 researchers who would work in the UK although only 45 grantees had UK nationality

Increase in 72% of active UK percentage of UK 19% 29% researchers have trained academic staff or worked as who are non-UK researchers abroad nationals: 2005/6 2015/16 Spotlight on 2017 | 23

Mobility to and from the UK

Regardless of duration, the USA, Germany and France are the most 80% common destinations for researchers of non-UK nationals in the from the UK. Australia, Canada and UK have EU or North Japan are also important destinations American nationalities

frequently cited barrier to uncertainty about the future of that it retains its reputation as mobility among researchers their research and profession an attractive destination for the with a partner. Other more post-Brexit, including their long- best international researchers. specific barriers to researcher term financial security. They However, UK policymakers mobility to the UK were the high reported feeling unwelcome in should also consider how best cost of living and the ability to the UK due to a perceived to address other more practical obtain work visas. increase in xenophobia and barriers identified in the uncertainty around the rights of Although not a focus of the study, for example by helping EU nationals. study, Brexit emerged as an international researchers to area of concern for researchers. Maintaining a high calibre and access a good standard of living International researchers variety of research in the UK and obtain employment for based in the UK expressed will be important in ensuring partners.

A stark finding was the pressure to be internationally mobile in order to have a successful career in academia

Sue Guthrie, lead author of this study, specialises in science, innovation and research policy 24 |

Later school start times Spotlight on 2017 | 25

Only about 40 per cent of the costs of delaying school US teenagers get the eight start times. These costs include to ten hours of sleep a night rescheduling bus routes, and recommended by sleep providing floodlights for after- scientists and paediatricians. school sports events and A major reason for this deficit training. is not biology or technology, Delaying school but public policy – specifically, Our study showed that the school start times. The overall economic gains would be start times to average nationwide start time realised through the higher 8.30 a.m. could of American middle and high academic and professional schools is 8.03 a.m. performance of students and contribute a reduction in car crash rates While the scientific evidence has among adolescents. always supported later school start times, the economic One additional hour of sleep $83bn impact has not previously been is estimated to increase the considered in much detail. probability of high school to the US In 2017, RAND researchers graduation and the college economy within conducted a comprehensive attendance rate. Both these analysis of the economic factors have a direct impact a decade implications of later school start on the future financial earnings times across 47 US states. of teenagers and their future contribution to the economy. Using a novel macroeconomic US states are beginning to model to project potential Motor vehicle crashes are explore later start times for economic gains, we found the number one cause of middle and high schools. In that a nationwide shift to an teenage deaths in the United 2017 California discussed a 8.30 a.m. school start time States, and around 20 per state-wide move to 8.30 a.m., could contribute $83 billion cent of car crashes involve a which is set to be re-examined to the US economy within a driver impaired by sleepiness, and debated in 2018. In addition, decade. Over the 20-year period drowsiness or fatigue. The other school districts across the studied, the US economy could impact of young adults dying United States are increasingly gain around $9 billion each year. prematurely has a negative effect on the future labour considering delaying school Within two years, the economic supply of an economy. start times. gain would already outweigh 26 | WHY DATA? Emerging and diverse types of data present new opportunities for research and innovation around complex societal challenges. In 2017, we explored the value of health and ambulance data in meeting some of these challenges in health systems and policing.

Using health data to improve health systems

Our work for the European Policy makers, however, will Federation of Pharmaceutical need to address a series of Industry Associations found that social and technical issues in greater access to and use of order to maximise the potential health data could provide diverse benefits of using health data, social and economic benefits to such as public acceptability, health systems. These include data regulation and governance helping improve the quality and issues, data quality and the efficiency of care, prospects ability to share data between for new types of research and different health system innovation, and empowering stakeholders. citizens to take a more active role in maintaining good health.

In a changing health data landscape, there is a need to consider a richer and broader array of data and evidence in decision making

Sonja Marjanovic leads RAND Europe’s work in the field of health data Spotlight on 2017 | 27

Using ambulance data to help fight violent crime

The last year saw violent crime volume of data, with ambulance be effective in reducing crime, in England and Wales increase call-outs for public violence the method would be easily by nearly 20 per cent, according incidents averaging 16 per scalable, since the data is to figures from the UK’s Office day in the West Midlands. collected automatically and for National Statistics. This suggests that ambulance requires little additional work to data could help build a fuller be collated and shared. In collaboration with West picture of the location and Midlands Police, our study, led characteristics of violent crime, by Alex Sutherland, considered to assist police in targeting whether ambulance data could resources more effectively. be used by police forces to help prevent violence. Our work has encouraged police forces to take more interest in We found that ambulance using ambulance data given Ambulance records data recorded significant new its ease of implementation, contain substantial information on violent incidents, cost-effectiveness and the high new and useful between 66 and 90 per cent of volume of recorded incidents. information on which were not found in police If ambulance data proves to data. There is also a high violent incidents 28 | Spotlight on 2017 | 29

What British people want from Brexit

The June 2016 EU referendum decisions. Using a chocolate bar Across the board – from result provided little information as an example, key attributes Leavers to Remainers, those about the sort of post-Brexit may be whether it is milk or dark with degrees to those with relationship that the British chocolate, how many grams the no educational qualifications, people want with the EU. Did bar weighs, whether it has nuts young to old – the British the vote to leave mean the UK and how much it costs. population on average viewed leaving the EU Single Market, access to the EU Single Market limiting migration to the UK, For this study, our aim was to and the ability to make free making the UK’s own laws quantify the attributes of the and/or making the UK’s own UK’s future relationship with the trade deals? EU that are most important to Respondents the British public. We focused To answer these questions, on seven key attributes including valued the current researchers from RAND freedom of movement, trade situation of EU Europe, the Policy Institute at deals, Single Market access, King’s College London and the law-making sovereignty and net membership University of Cambridge used contribution to the EU budget. at about ‘stated preference discrete choice experiments’ to try to The study showed that the quantify the British public’s British public want a Brexit deal preferences for the UK in a post- and are willing to compromise to get one. Taking all positives £14 Brexit world. and negatives into account, per household The principle of this respondents valued the current methodology is that goods situation of EU membership at per week more and services are described by about £14 per household per than leaving the the key attributes upon which week more than leaving the EU people base their purchasing with no deal. EU with no deal 30 | What British people want from Brexit

THE SEVEN ATTRIBUTES trade deals with other countries visa to travel to other European CONSIDERED outside the EU as the most countries for holidays and important attributes of the UK’s requiring other Europeans to future relationship with the EU. have a visa to travel to the UK. Freedom of movement for Controlling freedom of In fact, education level proved holidays movement, having sovereignty the most important explanatory over its own laws and variable in quantifying people’s minimising the amount that the preferences, with those with Freedom of UK contributes to the EU budget university degrees favouring movement for were also considered important closer ties to the EU and living and working by the British public. However, those with no educational views on these three issues qualifications favouring the were highly polarised. opposite.

Net contribution In general, British people would When views on all attributes to the EU like to see constraints on were combined, we found freedom of movement to some that the British public places extent. However, this mostly the highest positive value on seems to stem from concerns a future relationship with the Free trade deals about limiting demand for EU, similar to Norway’s current outside the EU valued public services. Some arrangement. This outcome people – particularly those with allows for free trade with other higher educational degrees countries while remaining within – strongly disliked severe the Single Market, and accepts Free trade of restrictions on freedom of freedom of movement and services in the EU movement, such as requiring a some loss of sovereignty.

Free trade of goods in the EU The British public want a deal and are willing to compromise to get one

Sovereignty Charlene Rohr specialises in choice modelling and was the RAND Europe research lead for this study Spotlight on 2017 | 31

Based on a survey of almost 1,000 members of the British public, who were asked to trade off different aspects of a possible agreement to exit the EU, we find that:

The British public want a deal

People are more concerned with managing demand for public services than simply restricting freedom of movement

People highly value having access to EU markets for trade in goods and services, but also would like the UK to be able to make its own trade deals

People value the UK being able to make its own laws, but not as much as Single Market access or the ability to make trade deals

People with degrees hold stronger views

People prefer a final agreement which is close to an agreement that is similar to the Norway model 32 | MIND matters

According to the World Health Organization an estimated 83 million working-age people across Europe have experienced at least one mental health problem. Our research attempts to understand the impact of poor mental health and wellbeing across the workforce, looking at multiple professions and sectors. Spotlight on 2017 | 33

Healthy workplaces

In 2017, we continued our productivity. In 2017, the work for VitalityHealth on its proportion of respondents annual Britain’s Healthiest who reported suffering from Workplace survey. The aim is moderate or severe depression to gain a better understanding increased to 6 per cent, up from Wellbeing of the health and wellbeing 4 per cent in 2016. Moreover, of the UK’s workforce, its two-thirds of employees programmes at impact on productivity and reported financial concerns, work have been how organisations can help which are widely known to be improve the physical and mental significant causes of stress and proven to have a wellbeing of their employees. also mental ill health. positive impact

Some 31,950 employees from The good news for employers on the economic, 167 organisations participated is that our survey feedback social and health in this year’s survey, which suggests that workplace health outcomes of covered large, medium-sized and wellbeing programmes do and small companies from have a positive impact. These individuals, across the public and private include initiatives to promote organisations and sectors. both physical wellbeing, such as running clubs, cycling to communities We found that an average of work and on-site gyms, and 30 working days are lost per also mental wellbeing, such staff member each year. This as relaxation classes and time is due both to absenteeism – management training. when employees do not show up for work – and also to Following our work in the UK, ‘presenteeism’, when employees we were asked by AIA Vitality to come to work but perform at a analyse the results from Asia’s sub-optimal level. Healthiest Workplace, a survey of the health and wellbeing of Chris van Stolk leads RAND Mental health problems can employees in Australia, Hong severely reduce employee Europe’s work on mental Kong, Malaysia and Singapore. health and wellbeing 34 | Mind matters

Researcher mental health

Although it has long been SIX ASPECTS OF WORK ARE suspected that academic RECOGNISED AS IMPACTING ON WORKERS’ STRESS: researchers and university staff face significant mental health challenges, there has been very Work demands little research focusing on these groups. The Royal Society and 32–55% Wellcome Trust asked RAND Europe to assess what is known of academics are about mental ill health in the at risk of having or Job control research environment. developing mental The limited evidence available health conditions suggests that the wellbeing of academic staff is worse than for mental health condition to Change most other types of employment. their employer. However, management In fact, we found that the levels between 32 and 55 per cent of burnout among university of academic employees are at staff match those of known high- risk of having or developing a Work risk groups, such as healthcare common psychiatric disorder, relationships workers. However, identifying putting academics among mental ill health among staff the occupations at greatest remains a significant challenge risk, alongside social care and Support provided for the higher education sector. teaching. by managers and One particular problem is staff colleagues not disclosing their mental health Our analysis suggests that the conditions. mental health and wellbeing of academic and university staff Recent UK national statistics is an under-acknowledged Clarity about show that only 6.2 per cent problem for the profession and one’s role of university staff disclosed a is yet to be fully addressed. Spotlight on 2017 | 35

Policy Research in Science assessments. PRiSM was at the Medical Officer and other senior and Medicine (PRiSM) was forefront of exploring science decision makers to access established in 2010 as a policy and its effectiveness, accurate and real-time data on collaborative research unit, while helping further the NIHR activity anywhere in the led by RAND Europe and understanding of the ‘science of world. the Policy Institute at King’s science’ in the UK, Europe and College London, to provide internationally. research-based evidence to the Department of Health for the Three key questions underpinned development of UK research PRiSM’s work. How can and development (R&D) policy funders support research and in health and social care. Over researchers to bring about its seven-year term, PRiSM the greatest good for society? delivered over 60 projects on a How do public R&D funders PRiSM’s study understand the impact of the vast range of topics including on dementia studies on dementia, mental research they support? And health research, cardiovascular which data help to make better helped to inform policy decisions in health and and stroke research, alternatives the Prime to peer review, evaluations of medical research? ongoing programmes supported Among other contributions, Minister’s 2020 by the National Institute for PRiSM helped to establish the Mental Health Health Research (NIHR), and a NIHR Dashboard, which feeds Challenge number of bibliometric studies into Prime Ministers’ Questions supporting research funding and also allows the Chief document 36 |

Healthcare solutions The UK healthcare system faces mounting year-on-year pressure to reduce costs while continuing to deliver high-quality services. RAND Europe has been involved in numerous studies to evaluate and analyse potential short- and long-term solutions. The future of health

In 20 years’ time the health Ageing populations pose in genomics, personalised landscape will look very the biggest challenge since, medicine and data use could different to today, given rapid despite living longer, people will potentially transform prevention, advancements in science and not necessarily be healthier, diagnostics and treatment, for technology, and demographic and England’s population will example to facilitate patient and societal changes. increasingly suffer from more self-management approaches. Understanding the future of complex illnesses. Unhealthy health is therefore paramount lifestyle choices, changing One concern is that these when developing strategies and patterns of infectious disease advances will further exacerbate priorities. and the rising prevalence of health inequalities. Healthcare mental health issues will add to delivery and organisation is To this end, the National Institute this complexity. expected to shift towards the for Health Research asked RAND more holistic, integrated models Europe to capture perspectives Surveyed experts identified of care and prevention needed from experts across health and advances in technology, to tackle increasingly complex science on the potential health medicine and data access physical and mental conditions. challenges England will face in that can be harnessed to 20–30 years’ time. improve healthcare. Advances Spotlight on 2017 | 37

The ‘telephone first’ approach

A recent initiative, where patients We found that the ‘telephone speak with GPs on the telephone first’ approach is by no means a before receiving face-to-face silver bullet for reducing costs or consultations, the ‘telephone meeting demand. While hailed first’ approach, is said to reduce in NHS literature as cost saving, waiting times for appointments, we found no evidence that it improve patient experience and saves money or reduces hospital reduce A&E attendance and referrals. emergency admissions. The National Institute for Health Far from reducing secondary We need care costs, we found that Research commissioned the to be careful Cambridge Centre for Health overall secondary care costs Services Research – a RAND increased slightly by £11,776 about seeing Europe and University of per 10,000 patients. There was ‘telephone first’ as Cambridge collaboration – to also no evidence to show that evaluate these potential gains. the approach substantially a panacea: while it reduced overall attendance at increases control A&E departments or emergency hospital admissions. over GP’s daily workload it does We did see a change in GP consultation patterns; however, not necessarily these changes were often decrease accompanied by an increase consulting time in GP workload. Telephone conversations increased twelve-fold and there was a considerable drop in face-to- The number face consultations. Overall, GP consulting time did increase by 8 of face-to-face per cent, though there was wide consultations variation between practices. The fall in face-to-face consultations with GPs fell by suggests that patients’ problems Jenny Newbould has a joint can often be dealt with over the post at RAND Europe and the phone, but this approach does Cambridge Centre for Health not necessarily suit all patients or Services Research and was 38% practices. lead author on this study 38 | Spotlight on 2017 | 39

Teacher shortages in Cambridgeshire

With the number of school- engineering and mathematics aged children in the UK county (STEM) subjects. of Cambridgeshire projected to increase over the next The other issue is that working ten years, Cambridge Ahead conditions in the county have commissioned RAND Europe to become less attractive since examine the extent of teacher 2010 compared to nationally. shortages and the factors Over this period, Cambridgeshire associated with this. We found teachers have been more likely that shortages could be a to earn a salary within lower pay real threat unless more new ranges, work part-time and work 19% secondary school teachers are under fixed-term or temporary contracts. of STEM secondary attracted and retained. school teachers in Our study identified two main As part of the solution, more Cambridgeshire are research is needed to explore possible causes behind the retiring but only shortages. One is an insufficient the association between certain replacement rate of teachers. aspects of teachers’ working and The gap between the proportions living conditions. Furthermore, of new entries and retirees additional data is needed to fully in Cambridgeshire is large understand the reasons why 11% compared to the national level, too few teachers are attracted are new entrants especially for secondary school to work in Cambridgeshire and to the region teachers of science, technology, why teachers are leaving the profession. 40 |

LOOKING BACK to plan ahead

The RAND Europe office in Delft (1994) Spotlight on 2017 | 41

BACK TO THE PAST health, science, innovation, Twenty-five years ago, the defence and security, transport, RAND Corporation established criminal justice, education, the European American Centre employment and social policy. for Policy Analysis (EAC). Housed in modest offices at the ALWAYS LOOKING AHEAD Delft University of Technology in As RAND Europe celebrates the Netherlands, RAND set out its 25th year, we look ahead to to create a European enterprise new opportunities to shape and with the same mission to help inform future policy. In the not- improve policy and decision so-distant future, RAND Europe making through research and will be celebrating another Over the past analysis. The team sought milestone: our ten-year presence ten years we have to create a permanent and in Brussels. This milestone distinctively European presence comes at a crucial time. The studied some that could also draw on RAND’s historic shift in relations between of the biggest established skills and expertise the EU and the UK following challenges the EU for the benefit of its European Brexit will have implications for clients. the whole continent of Europe has faced, including as new boundaries impact Hiring local researchers, the the migrant European policy making and EAC began its work as an collaboration. crisis, Brexit, impartial not-for-profit research radicalisation and organisation. Fast forward Our Brussels office will continue through a name change, several to be a hub for thoughtful pan- social policy office relocations and thousands European research, whatever the of projects, the small company final nature of these changes. that was EAC has grown and As we move into 2018, we are flourished into the RAND Europe excited to be working on projects we see today: a thriving research for a range of clients from the institute, with over 100 staff public, private and third sectors. based in offices in Cambridge Our dedication to research and Brussels. RAND Europe’s across Europe remains a knowledge has expanded to constant even as new challenges Stijn Hoorens heads the RAND cover a kaleidoscope of topics: for policy makers emerge. Europe Brussels Office 42 |

Events in 2017

DIGITISING HEALTHCARE Festival of Ideas – ‘You are learning, open science, digital Our distinguished speaker at the what you sleep’ – that explored currency and civic engagement. Cambridge Centre for Health the growing problem of sleep Speeches from RAND Europe Services Research’s (CCHSR) deprivation in society. Four President Hans Pung and annual lecture this year was panellists, including RAND’s Rachel Neaman, the CEO of Dr Robert Wachter, chair of the own Marco Hafner and Wendy the Corsham Institute, featured University of California San Troxel, highlighted different alongside a video message Francisco’s Department of impacts of sleep deficit, from from the digital minister Matt Medicine, bestselling author of its repercussions for the Hancock. ‘The Digital Doctor,’ and leader development of children and KEEPING TIES of the group that authored teenagers to its effects on the 2016 ‘Wachter Report’ on family life and relationships, RAND Europe hosted three digitising the NHS. Dr Wachter businesses and the wider receptions in 2017 to celebrate explained why digitising economy. The event was at full our 25th year of informing policy healthcare is so hard, and what capacity, with 150 attendees. across Europe. The events, needs to be done to get it right, held in London, Cambridge CONNECTED SOCIETY while drawing on examples from and Brussels, brought together the UK and the United States. To mark the second year of clients and collaborators to The CCHSR is a collaboration RAND Europe’s collaboration celebrate and discuss objective between the University of with the Corsham Institute on research and analysis. Our Cambridge and RAND Europe the Connected Society Thought guests heard speakers Carl that informs policy making Leadership Programme, we Bildt, former prime minister of through evidence-based held an event at the House of Sweden, and Jane Paterson- research on health services. Lords, which also launched Todd, Chief Executive of the new Observatory for a Cambridge Ahead, speak YOU ARE WHAT YOU SLEEP Connected Society. The event about the global geopolitical RAND Europe sponsored a was introduced by Lord Knight challenges we face today and public event for the Cambridge and showcased findings the importance of evidence in from 2017 research on digital policy making. Spotlight on 2017 | 43 44 |

Council of Advisors

The guidance RAND Europe 2014). Prior to this she was a with over 30 years of media receives from our Council of Member of the European Court experience. He was previously Advisors enriches our work of Auditors (2000–2010) and a foreign correspondent in New and helps us fulfil our mission an elected member of the Irish York and Washington, and a to improve policy and decision Parliament for 22 years. Since political correspondent in both making through objective her retirement from politics the former German capital research and analysis. The in 1997, Geoghegan-Quinn Bonn and in East Berlin during wealth of knowledge and diverse has held positions in both the German reunification. In addition experience of our council academic and private sectors. to overseeing BILD’s reporting members is of immense benefit She holds honorary doctorates of the news, von Heintze has to RAND Europe and our clients. in Science and in Law and has initiated campaigns on a range received several prestigious of important social topics, This year we were fortunate to awards, including the Légion including climate change and the welcome two new distinguished d’Honneur presented to her by 2015 European refugee crisis. members to our council: Máire then French President FranÇois Geoghegan-Quinn and Florian Hollande in 2014. MEMBERS SERVING IN 2017 Freiherr von Heintze. Florian von Heintze is the Michael D. Rich (Chairman) Máire Geoghegan-Quinn was Deputy Editor-in-Chief of BILD, President and Chief Executive EU Commissioner for Research, Europe’s best-selling newspaper, Officer, RAND Corporation Innovation and Science (2010– Spotlight on 2017 | 45

Paul Adamson OBE Philippa Foster Back CBE Professor David Howarth Partner and Chairman, Forum Director, Institute of Business Professor of Law and Public Europe; Editor-in-Chief, E!Sharp Ethics Policy, University of Cambridge

László Andor Máire Geoghegan-Quinn Gunvor Kronman Former Commissioner for Former Commissioner for Chief Executive Officer, Employment, Social Affairs & Research, Innovation and Hanasaari, the Swedish- Finnish Inclusion, European Union Science, European Commission Cultural Centre

Carl Bildt Florian Freiherr von Heintze Dr Gill Samuels CBE Former Prime Minister, Deputy Editor-in-Chief, BILD Member, Council of University Former Minister for Foreign College London Affairs, Sweden Susan Hitch Trustee, Science Museum Director of International Professor Dame Carol Black Relationships, The Listen Professor Sir Gregory Winter DBE FRCP FMedSci Charity CBE FRS Principal, Newnham College, Master, Trinity College, University of Cambridge Michael Hoffman University of Cambridge Chairman and Co-Founder, Sir John Boyd KCMG Palamon Capital Partners LLP Former Chairman, Asia House 46 |

Clients and collaborators

Public sector Foundations, charities and universities Private sector

Areas of expertise

The multidisciplinary nature of RAND Europe’s research, combined with our diverse staff, ensures innovative, high-quality work across a vast range of policy areas:

• Defence & security • Drugs, policing & criminal justice • Education • Employment, social inclusion, population & migration • Health & healthcare • International development • Science, technology & innovation • Transport • Wellbeing in the workplace

We employ robust and rigorous methods and capabilities, backed up by peer review, to ensure the integrity of all our research, including:

• Choice modelling & behavioural research • Economics & econometrics • Evaluation for better performance • Gaming • Randomised controlled trials To view more about the research featured in Spotlight please visit: www.randeurope.org/spotlight2017

Image credits Spotlight on 2017 team:

Adobe Stock Lizzy Iredale Lizzy Iredale p. 4, p. 6, p. 8, p. 11, p. 14, p. 5, p. 12, p. 16, p. 19, p. 23, Jack Melling pp. 19–20, p. 24, pp. 27–28, p. 26, p. 30, p. 37, p. 41 Jessica Plumridge p. 32, p. 38 Lynne Saylor iStock Joanna Anthony cover, p. 36 Lynette Gilbert p. 10, pp. 43–44 (Business Literacy) Francois de Ribaucourt Diane Baldwin pp. 43–45, p. 48 p. 1 The paper used in this The Noun Project publication is FSC® Certified Courtesy Corsham Institute p. 7, p. 9, p. 13, pp. 15–16, p. 43 pp. 21–23, p. 25, p. 27, pp. 30–31, pp. 34–35, p. 37, Courtesy RAND archives p. 39 p. 40 Domininkas Zalys Emilie Holba p. 43 p. 33 OUR MISSION RAND Europe is a not-for-profit research organisation that helps to improve policy and decision making through research and analysis.

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Canberra, AU CP-531(2017)