Examination of Witnesses (Questions 360
- 367)
FRIDAY 27 FEBRUARY 2009
Mr Dave Moxham
Q360 Lord Rowe-Beddoe:
Can I just go back to this question of the regions in England
which the Chairman has raised. I know this is outside our particular
remit, but the whole question of the funding of these parts of
England (if we do not call them regions for a moment) is a matter
for England under this concept. We have a Barnett Formula. We
are not entering into the political forum here and if it is accepted
eventually to replace the Barnett Formula, it will be for the
four constituents parts of the United Kingdom and Northern Ireland,
to determine how they are going to allocate the grant. That is
not satisfactory to you?
Mr Moxham: I believe that there would be enduring
difficulties in relation to the "felt fair" of the system
across England, which is after all the significant part in size
of the United Kingdom, and I believe there is certainly the risk
under that approach that we would not end up with felt fair across
the regions of England and therefore the stability of any future
settlement would potentially come into question.
Q361 Lord Forsyth of Drumlean:
Why do you make that distinction between a future settlement and
what we have now? I have now got the figures for what health spending
is by region in England and the North East is actually one of
the highest at £1,678 per head. The Scottish figure is £1,771,
which is higher than all the other regions of England and Wales
by quite a considerable margin. There is a big variation between
the parts of England from £1,402 in the South East to £1,417
in the South West, right up to the figure I have given you for
the North East, so within the existing distribution, which we
are not concerned with, in England you have a big variation between
the regions but all of them are considerably less than Scotland.
Do you think that reflects need?
Mr Moxham: It may well do but I would hesitate
to say that it definitely does. It certainly reflects the increased
cost of provision partially in relation to the geography, although
I concede the North East would have some issues in relation to
that, too, but we would need to then make a cross-comparison,
in my view, with morbidity rates.
Q362 Lord Forsyth of Drumlean:
I think the money is distributed by the Department of Health within
England on the basis of a formula which takes account of need,
which is why you get that distribution between them, and I have
no doubt that people argue—which is not our concern—about
what the North East gets, but the argument which I thought you
were referring to is the one that says why does Scotland get £1,700
and why is the overall level of expenditure on health higher in
Scotland. The fact that it is not actually possible to point to
a kind of needs-based assessment makes it very much more difficult
to justify that relative to the English regions. Is that not the
political difficulty?
Mr Moxham: Yes, that is an accurate position.
Q363 Lord Forsyth of Drumlean:
It is not so much about the distribution between the English regions
as about the overall provision relative to England and Scotland?
Mr Moxham: Yes.
Q364 Chairman:
It is also a perception, is it not, that unless you have got a
needs-based assessment which people broadly accept as fair, you
still get this argument going on between, say, the north-east
of England and Scotland about their respective allocations?
Mr Moxham: Yes.
Q365 Lord Sewel:
I think there is one thing we can agree on, if we do move to a
needs assessment of the type that you are advocating, it will
take a fairly long period of time, as you have said, to introduce.
Are there any aspects of the Barnett Formula as it operates at
the moment which cause you concern and worry and you would like
to see changed in an intervening period?
Mr Moxham: We have not given specific thought
to that. We are obviously aware that, in theory at least, over
a period of contracting public expenditure, as we expect to happen
now, that convergence would be slower. Taking into account the
potential for rising inflation and wage costs to influence that,
too, I think one of the clear problems that we have is that it
is actually very difficult to predict where the formula will have
us in five or ten years' time, and that is clearly a problem.
I tend to think that any attempts to tinker would probably just
produce further problems as opposed to clarifying the situation.
To be honest, I would defer to people who have done more work
on the operation of the mechanism itself rather than making specific
suggestions.
Q366 Lord Forsyth of Drumlean:
Is that another way of saying it is politically too difficult?
Mr Moxham: Yes, probably! I have yet to hear
of anybody who has any confidence about what a future formula
might look like.
Q367 Chairman:
Well, thank you very much indeed. You have made your views very
clear. I think a large chunk of it I find myself in agreement
with.
Mr Moxham: It would be of some disappointment
to me if I threw anything into the pot that was controversial.
Thank you very much for listening to me.
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