Freedom Of Information Research Articles

More open, more democratic or better at hiding? Two decades of local government transparency in the UK

ABSTRACT Local government has long been the site of experiments and innovation in transparency. Since the 1990s waves of reforms have sought to open up local government in Britain, from the Freedom of Information (FOI) Act in the 2000s to Open Data in the 2010s. This paper looks across the evidence to see how well these new transparency tools have worked, who is using them and why. It then moves to analyse what impact the changes have had on local government, in line with hopes of campaigners and fears of (some) politicians. Have reforms succeeded in making local government more open, more accountable and more participative, and in what situations? Or have they, as some claim, simply driven decision-making into other arenas, and made local bodies ‘better at hiding’? Finally, how does transparency sit with the fragmented and disjointed landscape of local politics today, from outsourcing and devolution to financial crisis?

SP8.1 - Emergency Robotic General Surgery in the UK: Operations, Staff, and Missed Opportunities

Abstract Aims The primary aim was to determine the volume of emergency robotic general surgery performed in the UK. Secondary aims were to determine compatible operations with opportunities for training and the availability of robotic-trained staff. Methods Freedom of Information (FOI) requests were sent to 122 UK Acute Trusts, asking for data on general surgery procedures (open, laparoscopic, robotic) from January 2019 to January 2023. Data on common emergency procedures, in-patient length of stay, robotic complications, and availability of robotically trained staff was requested. Results Of the 122 Acute Trusts, 22 did not respond (82% response rate), 32 had no general surgery robotic access, 16 could not comply due to cost (under section 12 of FOI Act), and 52 provided data. Fifteen Trusts performed emergency robotic surgeries: cholecystectomy (262 cases), hernia repair (140), and appendectomy (3). 86% of these Trusts utilized the DaVinci system, while the CMR Versius system was employed by the remaining 14%. There was a median of 12.5 (range 2-40) robotic-trained staff in-hours, versus a median of 0 (range 0-4) out-of-hours. Conclusions Emergency robotic general surgery in the UK is limited by financial constraints, staff availability, and selective procedural use. Compatible emergency operations that have been performed were cholecystectomies, hernias, and appendectomies. To expand its role, there's a need for training, infrastructure investment, and further research into the cost-effectiveness and outcomes of robotic surgery in emergency cases.

Analysing policy success and failure in Australia: Pink batts and set‐top boxes

AbstractThis article examines two Australian government programs from the Rudd/Gillard Labor government, the Home Insulation Program (HIP) and the Digital Switchover Household Assistance Scheme (HAS). Both became shibboleths of the Labor government's perceived waste and incompetence. Using key informant interviews and documents obtained under freedom of information (FOI), I analyse these programs against the multiple ‘dimensions’ of success proposed by Newman and common narrative frames around programme failure. I argue that the HAS was broadly successful across most dimensions of success, notwithstanding the adverse media attention. The study identifies four key factors driving HIP's failure: scheme design, installer training, demand control, and departmental expertise. All of these came back to the timeline pressures, driven by conflicting priorities, which in turn gave the Department of the Prime Minister and Cabinet (PM&C) more influence than would usually be the case. In comparison, HAS's success is attributed to crucial design choices, like the phased rollout and head contractor model. The article identifies the danger of ignoring subject matter expertise and poor policy/Cabinet processes, which have been reinforced by the recent Royal Commission into the Robodebt Scheme.Points for practitioners Demand‐driven programmes need to have demand‐side control techniques built into them. The role of central agencies needs to be carefully considered, particularly in relation to areas that are not their expertise, such as detailed programme development and implementation. Lessons about poor policy and Cabinet processes, as well as cultural change from the Pink Batts Royal Commission, do not appear to have been sufficiently embedded in the culture of the APS, as there are ongoing echoes of the same problems evident in the Robodebt Royal Commission.

The Violence of Peace: Post Good Friday Agreement Paramilitary Vigilantism in Northern Ireland

ABSTRACT This paper focuses on post Belfast/Good Friday Agreement paramilitary violence in Northern Ireland, specifically the vigilantism of paramilitary style attacks (PSAs) carried out by the loyalist and republican paramilitaries. This localised form of violence, formerly referred to as punishment attacks, has been the most persistent form of paramilitary violence in a post-conflict Northern Ireland. This paper critically analyses the broad criminological literature on the emergence of vigilantism, including consideration of factors impacting police confidence. The findings are applied to Northern Irish PSAs from 1998 to 2023. The author analyses data relating to Freedom of Information (FOI) requests to the Police Service of Northern Ireland. The results of these FOIs indicate that loyalist and republican paramilitaries combined have been responsible for 3,260 PSAs from 1998 to February 2023. Paramilitary republicans have been responsible for 1,196 attacks and loyalists responsible for 2,064. The article considers the post-Agreement evolution of this violence in terms of victims, injuries, geographical location, and police response. The most recent data indicate a downturn in PSAs. However, there are still significant challenges faced in the development of broader trust for the criminal justice system, within certain areas of Northern Ireland.

An evaluation of outpatient service provision in the National Health Service in Great Britain: A freedom of information request.

The National Health Service (NHS) Long Term Plan was published in January 2019. One of its objectives was restructuring outpatient services, as part of an Outpatient Transformation initiative. Monitoring of trusts' adherence to the objectives of the Long Term Plan is therefore required to benchmark progress against national objectives. We aimed to explore whether outpatient transformation initiatives and phlebotomy services that are managed by outpatients are appropriately staffed and to evaluate trusts' adherence to the objectives outlined in the Long Term Plan. A freedom of information (FOI) request was sent in January 2023 to 153 trusts across Great Britain (time span: 1 January 2022-31 December 2022). Parameters requested included number of outpatients seen/discharged, phlebotomy episodes, number of sites/wards covered by phlebotomy, target/actual did not attend (DNA) rates, time since inception of the outpatient transformation project (OTP), advice and refer (A&R) and patient-initiated follow-up (PIFU), phlebotomy and outpatient managerial establishment and use of electronic notes and patient portals. A total of 117 trusts (76.5%) provided responses to the FOI request. The mean number of new outpatients seen face-to-face was 185,810. Of 73 trusts reporting both actual and target DNA rates, 62 (84.9%) did not meet their DNA targets. The actual DNA rate was significantly greater than the target DNA rate across trusts (p < 0.001, mean: 8.8% vs. 6.5%, respectively). A total of 58 different electronic systems and 29 patient portals were utilised across trusts. Thirty-six trusts (30.3%) did not have an outpatient transformation project manager and 16 trusts (13.7%) did not initiate an OTP. With phlebotomy provision, the mean number of outpatient phlebotomy episodes was lower than inpatient episodes (83,383 vs. 91,020, respectively). There are deficiencies in current outpatient establishments that may hinder the achievement of objectives set in the NHS Long Term Plan. Changes at all levels of healthcare are required, with increased reliance on technologies and investment in support for transformation management.

Optimising intelligence operations for international law enforcement: harnessing THRIVE for national intelligence model advancement

ABSTRACT THRIVE (Threat, Harm, Risk, Investigation, Vulnerability, and Engagement) represents a decision-making framework introduced by the United Kingdom’s (UK) National Police Chiefs’ Council in 2017, with a particular focus on vulnerability. Alongside THRIVE other intelligence-led policing models such as the National Intelligence Model (NIM), have become integral to policing practices. While THRIVE is widely adopted as a primary analysis and decision-making framework in UK police services, its examination remains limited, including its impact on the NIM and its use by intelligence personnel. Interviews with 15 police personnel from operation intelligence units within a specific English service were conducted to ascertain its level of adoption. A series of Freedom of Information (FOI) requests to all 43 UK police services in England and Wales were then initiated, to understand if the THRIVE model is adopted and, if so, where within their respective units. The findings indicate widespread acceptance and integration of THRIVE among intelligence practitioners, without immediate adverse effects on the application of the NIM. The use of heuristic naturalistic decision-making processes in THRIVE assessments, suggests a need for further research. Though, there is a risk of reduced decision-making capacity among frontline intelligence workers using THRIVE within the constraints of the NIM.

Human milk products in the National Health Service: a cross-sectional survey of use and industry contact across England's trusts.

Commentators and professional organisations note that an expanding market in human milk-based products (HMBPs) could reduce breastfeeding, compromising maternal and infant health, and undermine public milk bank donations. We investigate whether English NHS trusts purchased these products and whether HMBP companies have marketed to them. Freedom of Information (FOI) requests asking: (1) whether trusts obtained human milk; (2) if so, how; and (3) whether HMBP companies had approached them. We analysed trusts' responses qualitatively. In 2023, an FOI request to the Food Standards Authority (FSA) following a product recall. England. One hundred and ninety-four NHS trusts, the FSA. Obtaining human milk, approaches by companies, and trust responses to approaches. One hundred and seventy-six trusts responded, 102 reporting human milk from milk banks. No trusts reported purchasing from companies in 2022. In 2023, the FSA confirmed six English hospitals used HMBPs from one company; an FOI for trusts' names was refused on law enforcement grounds. Two trusts reported participating in clinical trials funded by companies. Twenty-one reported approaches, using several strategies, including uninvited ward visits. Trusts rejected marketing based on guidance from: (1) trust dieticians or physicians; (2) regional regulatory bodies; (3) professional bodies; and (4) perceived application of an International Code on breastfeeding. Companies market to trusts, adopting methods previously used by the formula industry. Trusts express confusion over whether this infringes agreements designed to promote breastfeeding. We encourage clarification and guidance for professionals and trusts to ensure safety, infant and maternal health, and protect public provision.

PFAS Contamination in Europe: Generating Knowledge and Mapping Known and Likely Contamination with "Expert-Reviewed" Journalism.

While the extent of environmental contamination by per- and polyfluoroalkyl substances (PFAS) has mobilized considerable efforts around the globe in recent years, publicly available data on PFAS in Europe were very limited. In an unprecedented experiment of "expert-reviewed journalism" involving 29 journalists and seven scientific advisers, a cross-border collaborative project, the "Forever Pollution Project" (FPP), drew on both scientific methods and investigative journalism techniques such as open-source intelligence (OSINT) and freedom of information (FOI) requests to map contamination across Europe, making public data that previously had existed as "unseen science". The FPP identified 22,934 known contamination sites, including 20 PFAS manufacturing facilities, and 21,426 "presumptive contamination sites", including 13,745 sites presumably contaminated with fluorinated aqueous film-forming foam (AFFF) discharge, 2911 industrial facilities, and 4752 sites related to PFAS-containing waste. Additionally, the FPP identified 231 "known PFAS users", a new category for sites with an intermediate level of evidence of PFAS use and considered likely to be contamination sources. However, the true extent of contamination in Europe remains significantly underestimated due to a lack of comprehensive geolocation, sampling, and publicly available data. This model of knowledge production and dissemination offers lessons for researchers, policymakers, and journalists about cross-field collaborations and data transparency.

Tale of two requesters: How public records law experiences differ by requester types

The journalism industry was central to the materialization of U.S. freedom of information (FOI) laws, yet journalists frequently voice dissatisfaction with the state of FOI laws. The study surveyed 330 public records requesters on their experiences with FOI laws, finding public-interest requesters (journalists, academics, nonprofits, and private individuals) reported a significantly different experience, including a lower likelihood of receiving records, than for-profit requesters (commercial requesters and lawyers). For-profit requesters were less likely to believe FOI laws positively impact government accountability or improve society. The findings suggest reassessing whom the laws serve and whether they meet their original democratic objectives.

Adoption of routine surgical video recording: a nationwide freedom of information act request across England and Wales

Surgical video contains data with significant potential to improve surgical outcome assessment, quality assurance, education, and research. Current utilisation of surgical video recording is unknown and related policies/governance structures are unclear. A nationwide Freedom of Information (FOI) request concerning surgical video recording, technology, consent, access, and governance was sent to all acute National Health Service (NHS) trusts/boards in England/Wales between 20th February and 20th March2023. 140/144 (97.2%) trusts/boards in England/Wales responded to the FOI request. Surgical procedures were routinely recorded in 22 trusts/boards. The median estimate of consultant surgeons routinely recording their procedures was 20%. Surgical video was stored on internal systems (n=27), third-party products (n=29), and both (n=9). 32/140 (22.9%) trusts/boards ask for consent to record procedures as part of routine care. Consent for recording included non-clinical purposes in 55/140 (39.3%) trusts/boards. Policies for surgeon/patient access to surgical video were available in 48/140 (34.3%) and 32/140 (22.9%) trusts/boards, respectively. Surgical video was used for non-clinical purposes in 64/140 (45.7%) trusts/boards. Governance policies covering surgical video recording, use, and/or storage were available from 59/140 (42.1%) trusts/boards. There is significant heterogeneity in surgical video recording practices in England and Wales. A minority of trusts/boards routinely record surgical procedures, with large variation in recording/storage practices indicating scope for NHS-wide coordination. Revision of surgical video consent, accessibility, and governance policies should be prioritised by trusts/boards to protect key stakeholders. Increased availability of surgical video is essential for patients and surgeons to maximally benefit from the ongoing digital transformation of surgery. KL is supported by an NIHR Academic Clinical Fellowship and acknowledges infrastructure support for this research from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).

The Right to Transparency in Public Governance: Freedom of Information and the Use of Artificial Intelligence by Public Agencies

What information should and can be transparent for artificial intelligence (AI) algorithms? This article examines the socio-technical and legal perspectives of transparency in relation to algorithmic decision-making in public administration. We show how transparency in AI can be understood in light of the various technologies and the challenges one may encounter. Despite some first steps in that direction, there exists so far no mature standard for documenting AI models. From a legal perspective, this article examined the applicable freedom of information (FOI) regimes across different jurisdictions, with a particular focus on Denmark and other Scandinavian countries. Despite notable differences, our findings show that the FOI regimes generally only grant access to existing documents, and that access can be denied on the basis of the wide proprietary interests and internal documents exemptions. This is why we ultimately conclude that the European data-protection framework and the proposed EU AI Act — with their far-reaching duties to document the functioning of AI systems — provide promising new avenues for research and insights into transparency in AI.

Hostile healthcare? Initial insights into the landscape of charging policies in the NHS in Wales

The NHS is now firmly positioned as a site of immigration control. As the Hostile Environment filters further into the NHS the principle of universality is increasingly disputed. As such, paradoxically, harm is reproduced through an institution which is intended to provide care. Despite the increasing breadth of recognition of the implications of charging migrants within the NHS in England, insights into specific practices within Wales are limited. Therefore, this research starts to address this paucity by providing initial insights into the extent of NHS charging within Wales. The results from multiple freedom of information (FOI) requests sent to all seven health boards in Wales (carried out between January 2019 and August 2023) suggest that NHS treatment charging is common at scale across all health boards providing secondary care in Wales. In some instances, patients are being charged 150% of the cost of their treatment, and a significant number of patients are being incorrectly charged for care. It also appears that many patients have difficulty paying these charges, with significant outstanding invoices and many health boards resorting to using debt-collection agencies and/or payment plans in an attempt to elicit payment, and patients’ details being shared with the UK Home Office as a result. Considering the harms which are produced through NHS charging regulations, campaigners and advocates including Patients Not Passports Wales call for charging regulations to be withdrawn from the NHS in Wales and across the UK.

Public-Private Partnerships in Mexico: Implications of Engaging With the Food and Beverage Industry for Public Health Nutrition.

In the last few years, Mexico adopted public health policies to tackle non-communicable diseases (NCDs), such as front of package nutrition labelling, food marketing restrictions to children, and a soda tax. In parallel, transnational food and beverage industries (F&BIs), their allies, and the government have agreed on public-private partnerships (PPPs) to implement policies or deliver programs. However, research has questioned the benefits of PPPs and exposed its limitations as a suitable mechanism to improve public health. This study analyses how four PPPs between the Mexican government, the F&BI, and allies are working to achieve their goals. We critically assessed the objectives, scope, reported impacts, governance principles and perceived risks and benefits for the public health agenda of these PPPs. This qualitative study is based on 26 interviews with key actors, and 170 publicly available documents, including 22 obtained through freedom of information (FOI) requests related to four purposively selected PPPs aiming to improve health. We found that the four PPPs studied had minimal public information available on their implementation and impact. The private partners tend to dictate the design, information management, and implementation of the programs, while promoting their brands. Few independent evaluations of the PPPs exist, and none reported on their effectiveness or public health benefits. Good governance principles, such as accountability, transparency, fairness, participation, integrity, and credibility, were barely followed in each of the cases studied. Public officials did not automatically question the conflict of interest (CoI) of such arrangements. When there were COI, the potential risks these posed did not always outweigh the financial benefits of working with the F&BI and its allies. The four PPPs studied produced minimal gains for public health while boosting credibility for the participating transnational F&BIs. It shows the lack of awareness of how these PPPs might be hindering public health gains.

Response, awareness and requester identity in FOI law: Evidence from a field experiment

Freedom of Information (FOI) is considered a crown jewel of reforms fostering public administration transparency and accountability. However, FOI's symbolic power alone cannot overcome the organizational barriers and obstacles to its effective implementation. This paper presents the results of a field experiment performed in Italy, a late FOI adopter, where an FOI request was sent to the 307 municipalities with more than 30k inhabitants. The experimental design exploits marginal wording variation in the requests to test whether municipalities discriminate between ordinary citizens and high-profile requesters. The experimental evidence suggests that most Italian municipalities reply to FOI requests. The results show two opposite types of discretionary bias: Northern municipalities tend to favor high-profile requesters, whereas Southern municipalities tend to respond to them with a higher degree of attrition. The study investigates the determinants of this difference.

The importance of context: re-examining the ‘deployments’ of SWAT teams in Canada

ABSTRACT Based on an analysis of data released through Freedom of Information (FOI) requests, Canadian researchers have suggested that Special Weapons and Tactics (SWAT) teams are no longer exclusively deployed to resolve high-risk incidents but now frequently respond to routine calls that do not necessitate their involvement. Given concerns about these conclusions, we submitted the same FOI requests to the 14 police agencies examined by Roziere and Walby [2020. Special weapons and tactics teams in Canadian policing: legal, institutional, and economic dimensions. Policing and society, 30 (6), 704–719] and worked with the FOI analyst from each agency to ensure that the data were being interpreted correctly. Based on our re-analysis of the FOI-released data, we report on two problems with the conclusions reached by Roziere and Walby: the conflation of incidents where any SWAT officer responds to calls with full SWAT team deployments and the masking of potential risk factors in calls when relying on call type categories. Our findings illustrate the value of police agencies disclosing relevant contextual information to researchers when possible and they reinforce the necessity of collaborating with FOI analysts to better understand the data being released.

FREEDOM OF INFORMATION IN MALAYSIA: INTERNATIONAL LEGAL INSTRUMENTS AND RESTRICTIONS UNDER NATIONAL LAW

The acceptance of Freedom of Information (FOI) as a fundamental mechanism for enhancing accountability and transparency in the public sector is widely recognized. Numerous international legal instruments (Conventions) have advocated for the establishment and enforcement of legal frameworks pertaining to the FOI. The FOI legislation serves two essential functions, namely enhancing democratic engagement and mitigating corruption within the public sphere. Despite the acceptability of FOI on the global stage, Malaysia lacks a comprehensive legal framework to address the right to access information, except for Selangor and Penang. Additionally, there are various national legislations that hinder the exercise of FOI. This article’s objective is to examine the use of the FOI concept within the framework of international legal instruments as well as the challenges posed by Malaysian national laws that impose limitations on its implementation. The objective is achieved by employing a doctrinal methodology that incorporates international legal instruments as well as Malaysia’s legislations (Constitution, Acts and Enactments) pertaining to the FOI. The findings show the restrictions under national law make it difficult to implement FOI legal regimes in Malaysia. This paper argues that implementing FOI can only be materialized through a comprehensive review of existing laws and administrative structure reform by adapting universal standards on FOI as stated under international legal instruments. This article serves as guidelines for policymakers intending to address FOI as the anti-corruption mechanism in public sectors. Moreover, recommendations are made for the implementation of FOI into Malaysia’s domestic laws.

Power and Public Administration: Applying a Transformative Approach to Freedom of/Access to Information Research

Freedom of Information (FOI) or Access to Information (ATI) legislation regulates the right to make written requests for government records. Previous research either interrogates the effectiveness of FOI/ATI legislation for advancing government transparency or positions the requests as a means for gathering data on government institutions. This article intervenes in this debate by treating FOI/ATI mechanisms as the vantage point from which to examine questions about power in public administration. Adopting a transformative approach, this article explores the potential of using FOI/ATI requests as a liberatory tool that enables the analysis of power dynamics in public administration. For this purpose, the author draws upon her experience with Canada’s ATI regime and requests from the Immigration and Refugee Board. This article documents how ATI requests reveal policy tensions within the Board related to case and performance management, as well as patterns of front-line staff resistance to these measures. It goes on to examine complaints about delays made to the ATI watchdog which expose the attribution of ATI resources towards non-ATI responsibilities. This article highlights the contribution that FOI/ATI requests can make to public administration research.

The UK prosthetic and orthotic workforce: current status and implications for the future

BackgroundProsthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision.MethodsTo gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022.ResultsThe P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they “definitely” planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation’s (WHO) recommendation.ConclusionsThe low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape.

Dinâmica Política da Formulação da Política de Acesso à Informação no Brasil

Abstract Freedom of information (FOI) policymaking in Brazil is portrayed as a “successful story.” Data on adherence of the Brazilian legislation to international standards indicates its FOI institutions are in the top-ten group in the substantive dimension of FOI but are the last when it comes to the procedural dimension. What mechanism has driven this process to produce such ambivalence? This study assumes that FOI policymaking in Brazil represented an ambiguous legitimacy-based emulation process, oriented toward homogenization to the international field, but without breaking the governmental control over information. It draws on theoretical work on policy diffusion focusing on emulation and uses theories on conflicts and negotiation for power as drivers of policymaking. The results suggest this process was forged by political dynamics of disputes and compromises, and its outcomes derived from political trade-offs between key actors on controversial issues. Thus, the results materialized the preferences of non-governmental actors for a larger scope and no “eternal secrecy” and assured government offices’ prerogatives on implementation and their final decision on appeals. This case may represent a broader phenomenon, considering that comparative data indicates that this ambivalence in adherence between substantive and procedural dimensions is more significant in Latin America than in other regions.

Feasibility of Freedom of Information Requests for Amputee Epidemiology in the United Kingdom.

While each of the 44 National Health Service commissioned artificial limb clinics in the United Kingdom record information about their own prosthetic limb users, these are not collated to give a national picture of amputee epidemiology. The requirement to respond to Freedom of Information (FoI) requests within 20 working days offers another way of extracting data from all centres, and this study describes a first attempt to use this method to update national epidemiological data. Questions were sent to the FoI email addresses of all 44 centres, requesting numbers of adult unilateral below-knee amputees, adult unilateral above or through-knee amputees and child unilateral above or through-knee amputees (all of K2 level mobility), numbers of people consistently using a prosthesis with a single axis myoelectric hand, and access to an occupational therapist with skills to teach someone to use a myoelectric hand. A FoI request was sent to NHS England seeking release of data that they collect every month from all the prosthetic services which they commission in England. All but one of the UK centres responded, the great majority within 31 days. Incomplete results were generally due to centres finding the questions ambiguous and many did not record mobility levels consistently. While 33 centres had access to skilled occupational therapy, only 4 reported more than 10 patients who constantly used a single axis myoelectric hand. Eighteen centres were unable to provide complete data, and the remainder reported a ranges of 5 to 992 below-knee amputees, 7 to 574 adult above-knee amputees and 0 to 137 child above-knee amputees, suggesting different approaches to managing missing mobility level data. Freedom of Information requests are an inexpensive way of gathering data from NHS prosthetic clinics, which can identify age, sex, level of amputation but not activity levels or use of a prosthesis and hence only gives limited demographic information of the amputee cohort.