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Rob Marris: I would be concerned, if the hon. Gentleman had not quoted selectively. I shall read out the whole sentence, which I dislike intensely because it starts with a conjunction:
"But these estimates take no account of quality improvement, as the Atkinson Review recommended should be the case."
The hon. Gentleman's implication that the Chancellor has adopted a pick-and-mix approach is not fair. I say to hon. Members in all honesty that I have no idea what the Atkinson review is, but it is presumably about NHS productivity.
Rob Marris: I am not foolish enough to take interventions on what it is. Nevertheless, an apparently independent body that is dealing with productivity takes a view that is shared by the Chancellor.
David Taylor (North-West Leicestershire) (Lab/Co-op): The hon. Member for Beverley and Holderness (Mr. Stuart) quoted with approval the increase in productivity rates in the health service in the period before 1997. However, it is a fairly well understood economic principle that when one brings into productive use resources that were unused on the scale that was the case under that Government, they are generally less productive, and therefore average productivity is bound to decline. It is the law of diminishing returns. There is nothing special about having high levels of productivity—that can be achieved by sacking the least marginal resources in any productive enterprise.
Rob Marris: I agree with my hon. Friend, who, as a cost auditor by background, is much more knowledgeable about these matters than I am. As regards what was going on in the NHS in 1997, I was a trade union solicitor working closely with the Unison branch at the main acute hospital in Wolverhampton, as well as the branch at the health authority which became the primary care trust. The hospital was doing what in industrial terms would be called sweating the assets, which was wearing out staff.
Mr. Graham Stuart: In response to the hon. Member for North-West Leicestershire (David Taylor), in private business it would usually be expected that if one invested more, particularly if one doubled expenditure in an area, one would expect a step change upwards in productivity rather than the opposite.
To try to take a little heat out of the debate, I think that it is generally accepted within the NHS—and even among health Ministers—that productivity is a problem. That is one of the reasons why the record investment that has gone in is not delivering. We can all move forward if we at least accept that there is a serious problem. Whoever is in government in the next five to
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10 years, we must all work together in this House to support common-sense steps to increase that productivity.
Rob Marris: I would not agree with using the word "problem" about productivity in the NHS, but I completely agree that it is an issue that a Government of any colour need to address. All that I was saying—I did not want to get bogged down in this—was that it is very difficult to measure productivity in the NHS and that there is a social dimension because it is a public service.
Mr. Kevan Jones (North Durham) (Lab): Although this anoraks' debate between my hon. Friend and the hon. Member for Buckingham (John Bercow) is important and enlightening, does he accept that the main thing that my constituents are bothered about is waiting times? When I was first elected to this House in June 2001, the average waiting time for elective surgery was 18 months to two years—now, because of the extra investment that has gone in, it is down to four months.
Rob Marris: I entirely agree with my hon. Friend. There is a similar situation in Wolverhampton at the acute hospital, New Cross.
Rob Marris: I will give way to the hon. Gentleman, but I should first say something that I should have said in response to his last intervention, when he kindly talked about my prescience. I thought that he might have acknowledged my prescience in terms of having been able to get as far as box 2.2 on page 22 of this obscure report, which was released only two hours ago.
John Bercow: I am happy to pay due—indeed, elaborate—tribute to the hon. Gentleman for that capability. I do not intend to probe him on the details of the Atkinson review, of which I suspect both of us are pretty ignorant. However, it will be a very sad state of affairs if at the next election the Chancellor is reduced to trudging around the marginal seats of this country in his campaign bus chuntering, in response to any protesting elector, the slogan, "The Atkinson review! The Atkinson review!" I think that in such circumstances he will be thought to be in need of some assistance or treatment. Does the hon. Gentleman accept that the central issue—
Mr. Deputy Speaker (Sir Michael Lord): Order. I am conscious that interventions are getting longer and longer. Many Members are waiting to catch my eye, so I think that that is enough from the hon. Gentleman for the time being.
Rob Marris: I will not be tempted much further down this path save to say that as someone in a marginal seat, I will be more than happy during the next general election to welcome the Chancellor, whoever she or he may be.
Mr. Redwood:
Is not the worry about the NHS that there has been such a large build-up in non-medical personnel at the time when all this money has gone in? Would not the investment be proving its worth if the
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new computer systems and administration systems showed that we could cut the number of administrative staff, where surely his quality objection would not come into play? We have more administrative staff than nurses or doctors, so should not we spend to reduce that burden?
Rob Marris: I suspect that the right hon. Gentleman comes from a more commercial background than I do, but I too come from a business background—I spent the majority of my working life in the private sector. One should not simply rely on a commercial model as regards NHS finances and structures, and I am not suggesting that the right hon. Gentleman takes that view, but it can be illuminating to use it for comparison purposes. Arguably, the NHS was for years unadministered. The statistic that the right hon. Gentleman cites, which is commonly cited by Opposition Members, is one of those that can be extremely misleading in certain hands. For example, in some statistical, taxonomic sense—to use the kind of word that the hon. Member for Buckingham would use—a matron could be counted as an administratrix, to use the proper Latinate originate, or an administrator, in everyday terms. But most people, including, I suspect, the right hon. Gentleman, would not consider a matron—we reintroduced them, of course—to be an administrator or manager when looking at the figures to determine who is front-line and who is not.
Alan Simpson: One example of the difficulty of setting productivity measures in the NHS is to be found in the parallel debate about productivity in health care that is taking place in France at the moment. There, people are arguing that it is productive to reduce bed occupancy rates because their measures of efficiency are to be based on reductions in readmission rates and hospital infection rates. So, to make the system less intensely used is to make it better, in terms of productivity in health care. To use strict numeric terms in regard to volume throughput might therefore miss some of the really critical health issues on which productivity ought now to be measured.
Rob Marris: Absolutely. My hon. Friend makes an important point. It is extremely difficult to measure productivity, particularly in the social or public sectors.
Another measure of productivity—which Opposition Members, especially those on the Conservative Benches, never cite, but which I always have to cite in Budget debates—relates to our work force, and its participation rate of 75 per cent. There is indeed a gap between us and France in terms of output per person-hour. That is true. It is quite a significant gap, although we have halved it in recent years, as the Chancellor pointed out in his Budget speech. However, in terms of output per person of working age, there is almost no gap at all.
Economists have traditionally used output per person-hour as their primary measure of productivity, for understandable reasons; it is an extremely valuable tool for a business that is planning investment, for example. For society, however, it is much more important to look at the output per person of working age, because that tells us not only about relative measures—as productivity per person-hour does—but about the absolute size of the pie to be divided up for
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public services according to the national wealth. Productivity per person of working age is an extremely important measure, given our labour force participation rate and our achievements so far on skills, about which I shall say more later.
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