Examination of Witnesses (Questions 60-66)
MR ROBERT
CHOTE, PROFESSOR
PETER SPENCER,
MR DAVID
WALTON AND
MR MARTIN
WEALE
9 DECEMBER 2004
Q60 Angela Eagle: But it is not necessarily
the case that there would be one measurement for the very reason
that you are talking about. There is also a balance surely between
measuring quantity by which often efficiencies are measured and
quality is often an issue rather than merely throughput and it
is not production in the same way as you might measure manufacturing,
so clearly we have to have a more sophisticated approach to measuring
efficiency and outputs in the public sector. It seems such a neglected
area of endeavour for economists.
Mr Weale: Well, quality issues
also arise in the private sector in very substantial ways, for
example, changes in the nature of computers, but certainly I would
welcome any more effort that the Government and the research councils
do put into encouraging work in this area and I agree with you
that measurement issues are terribly important and it is very
difficult to establish any sort of consensus before you have got
on to a consensus about measurement. I think the Minister of Health
has said that measuring the output of the Health Service is one
of the most important issues facing us and I agree with that.
Q61 Angela Eagle: Does anyone have any
view that we will be able to come to a fairly sensible approach
to this measurement issue since £13 billion of extra money
is being spent investing in the public sector this year, although
not all that was allocated has been used, and it is clearly important
that we can get a handle on how well that money is being spent
and some views of value for money that enable us to have confidence
that this investment is being used properly and efficiently?
Mr Weale: Well, I agree with that.
Q62 Angela Eagle: When are we going to
be in a situation when we can make some of that assessment?
Professor Spencer: It is inevitably
very difficult to develop macroeconomic statistics generally,
but in particular when you are trying to aggregate and average
out over all of the various different indicators for something
as nebulous as the output of the healthcare industry, it is very,
very difficult to produce one number which is as solid as the
number of cars produced by the car industry and we are never going
to be in that situation. We can do our very best and there is
plenty of room for improvement and there are all sorts of new
methodologies that could be tried. Ultimately this comes down
to the consumer test and that is why the kind of focus groups
that are being set up right the way across the country to look
at the experience of ordinary people with the National Health
Service and to monitor their reactions to those improvements are
important. That may be a little bit more informal, but that is
the kind of measure, that is the kind of information that is going
to tell you whether we are getting value for money or not.
Q63 Angela Eagle: Yes, the Holy Grail
might not exist in the form of one number.
Professor Spencer: Yes, exactly.
Q64 Angela Eagle: What do you think of
the technical efficiency, the efficiency technical notes that
departments have been asked to produce? Have you had a chance
to look at them to see whether they are assisting and casting
light on this area?
Mr Chote: They do not go to some
of the fundamental problems that Peter has mentioned, and I think
another one is that with many public sector services there is
obviously a social and redistributional element in the quality
of the output as well, so, for example, it is quite hard to think
about how would you define the output of a library service. You
could well imagine that if you did have some sort of clear idea
about what the output of it was, presumably politically you would
not be indifferent between one possibility which had one large
library serving a very large area, but marketed very heavily at
people around it, so heavy use was made of it, versus having small
ones that people could access closer to them. Now, the latter
might be less efficient, but you would presumably value its output
more highly for social and equitable reasons, so I am not sure
that any measurement will get you away from those sorts of trade-offs
which are inevitable in deciding what you actually want out of
these services.
Q65 Angela Eagle: But perhaps it just
highlights them, so at least people would know about the implications
of the choices they are making.
Mr Weale: I think also in many
cases we do not have a completely clear consensus on what, say,
the Health Service is for. For example, there is increasing pressure
on it to provide alternative therapies. Now, I am not a doctor,
but one could quite easily imagine that some of those have no
medical value at all, but, nevertheless, the focus groups that
Peter described suggest that consumers are happy with them because
these treatments are available. Now, is that money being wasted
or is it a sensible use of taxpayers' money? It is a difficult
judgment.
Q66 Angela Eagle: Do you have a view
on the efficiency technical notes?
Mr Weale: I am afraid I do not,
no.
Chairman: On Martin's point about the
Health Service, I was at a meeting a couple of years ago when
someone advocated that we have suntan cream for people going out
to Spain just in case they get any illnesses, so what the Health
Service is used for is a big question. Thank you for that and
now we will move on to the micro issues.
Mr Cousins: Or insect cream if they go
to Scotland!
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