Evidence submitted by the Office for National
Statistics (WP 75)
1. INTRODUCTION
ONS publishes statistics which can provide contextual
information for the Health Select Committee's inquiry into "Workforce
needs and planning for the health service". These are:
— Public Service Productivity: Health
— Labour productivity; and
— Public Sector Employment.
This note provides a brief description of these
statistics, and links to more details online. ONS welcomes the
opportunity to provide further information and discuss.
2. HEALTH PRODUCTIVITY
In July 2005, the National Statistician accepted
the broad recommendations set out in the January 2005 final report
from Sir Tony Atkinson's review into the Measurement of Government
Output and Productivity for the National Account. At the same
time, ONS set up the "UK Centre for the Measurement of Government
Activity" to take forward the work involved.ONS has published
two articles on health productivity, entitled Public Service
Productivity: Health. These articles provide information on
total factor productivity of the NHS—that is productivity
associated with all of the goods, services, labour and capital
used by the NHS. These articles do not provide information on
labour productivity, although the calculations do include measures
of NHS labour. These articles differ in scope compared with other
ONS publications on productivity, as suggested in their title.
These articles cover "public service" rather than "public
sector". The articles report estimates of productivity relating
to public expenditure on health, irrespective of whether it is
the public or private sector that provides the health service.
The first article, published in October 2004,
presented estimates of NHS inputs (the goods, services, capital
and labour used in providing health services), NHS outputs (the
activities operations, GP appointments—Provided by the NHS)
and NHS productivity (defined to be the ratio of the volume of
output to volume of inputs), as well as what Sir Tony Atkinson
termed "triangulation material"—evidence that
might corroborate the implied productivity estimates. This first
article did not take explicit account of quality change in the
NHS: the output and productivity estimates did acknowledge changes
in the number, say, of operations carried out, but they did not
pick up changes in the quality of those operations.
Atkinson regarded measurement of quality change
in health care as difficult. He also pointed out that quality
of health care has a number of dimensions, including saving lives
and extending life span, preventing illness, speed of access to
treatment and quality of patient experience.
The second article, published in February 2006,
drew on proposals for measuring aspects of quality change published
in two research publications in December 2005: one by a consortium
involving the National Institute for Economic and Social Research
(NIESR) and the Centre of Health Economics at the University of
York; the second by the Department of Health. The York/NIESR publication
includes experimental labour productivity estimates for the NHS.
Publication of a third ONS article is planned
for the end of the 2006-07 financial year.
http://www.statistics.gov.uk/articles/nojournal/PublicServiceProductivityHealth(27_2_06).pdf
http://www.statistics.gov.uk/articles/nojournal/Sources_and_Methods.pdf
http://www.statistics.gov.uk/articles/economic__trends/ET613Lee.pdf
http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAnd
Guidance/
PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4124266&c
hk=5QmbY7
http://www.york.ac.uk/inst/che/
3. LABOUR PRODUCTIVITY
ONS produces estimates of labour productivity
for the whole economy by hour worked—the internationally
preferred measure—and also by worker and by job, along with
unit wage costs. However, no estimates are currently produced
for the public sector or any part of it. More detail is provided
for the manufacturing industries and experimentally—for
the service industries but these are for those industries across
the public and the market sectors combined.
Labour productivity is published quarterly.
The most recent "Productivity First Release" gave estimates
for 4th quarter 2005; this was published on 30 March 2006.
http://wvvw.statistics.gov.uk/productivity http://www.statistics.gov.uk/StatBase/Product.asp?vink=7476
4. PUBLIC SECTOR
EMPLOYMENT
Statistics of employment in the NHS are obtained
by ONS, as part of the process of producing statistics on public
sector employment. They are compiled using estimates provided
by the NHS Health and Social Care Information Centre (for England),
the Scottish Executive, the National Assembly for Wales and the
Department of Enterprise, Trade and Investment for Northern Ireland.
The statistics presently depend on projections, based on annual
data, in order to provide quarterly estimates in line with other
public sector employment statistics, and are thus subject to revision.
The figures go back to 1991. The GP workforce is classified as
part of the private sector in accordance with economic accounting
principles, and is excluded from the public sector returns, although
some data are available separately if required.
The figures are produced on numbers of people
employed and also in terms of full-time equivalents. There is
some information available on NHS employees by occupation although
the classifications used vary for different parts of the United
Kingdom. Some possibility exists of using analysis from the Labour
Force Survey (LFS) for more detailed and systematic breakdowns
such as occupation, although there are limitations to the quality
of such LFS data which could be obtained on the NHS as they depend
on information collected from individuals about the organisation
they (or, by proxy, other members of the household) work for.
While the LFS is a good source of information about employment
generally, comparisons between the LFS and employer-based sources
indicate that the LFS variables for type of organisation and industry
both suffer from reporting error. ONS is investigating the feasibility
of linking LFS records to the register of businesses maintained
by ONS, to improve the quality generally of the LFS results for
type of employer and industry.
A major issue in using any of these available
estimates of NHS employment as a basis for measurement of productivity
is how to align them with corresponding outputs or functions.
Many outputs which result from NHS funding will depend at least
partly on NHS employees not readily identified as contributing
to those outputs and also on some input from people not directly
employed by the NHS.
http://www.statistics.gov.uk/StatBase/Product.asp?vink=13615&Pos=&ColRank=1
& Rank=422
Karen Dunnell
Office for National Statistics
April 2006
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