Examination of Witnesses (Questions 80-99)
MAVIS MCDONALD CB, PROFESSOR RON AMANN, DR DAVID SALISBURY CB AND MR STEPHEN CROWNE
MONDAY 21 JANUARY 2002
80. Congratulations, I am very, very impressed.
(Mavis McDonald) I think it is fair to say that some of the approaches that were taken have been used across Whitehall in handling other types of vaccines.
81. Can you give us some examples of where a system like that has been put in place in other departments and policies were being picked out that were not working? You have told me about the literacy one, you have told me about the meningitis one, let us have a dozen other ones?
(Mavis McDonald) The new Civil Contingencies Unit secretariat in the Cabinet Office is setting up a central risk assessment capacity to do some forward thinking about the domestic risk of a whole range of things we have experienced over the last 12 months and others as they may arise. Some of its thinking is influenced and it has learned from some of the approaches that actually developed.
82. You are still not giving me any examples. We have one example on the bottom of page 35, a good example of effectively early warning, "A good example of a relatively simple but effective early warning mechanism is reports on the nature of citizens' requests for advice collected by the National Association of Citizens Advice Bureaux". Give me some other examples of where mechanisms were put in place and policy is said not to be working?
(Mavis McDonald) The basic system
83. Give me some examples, otherwise you are spending millions of pounds and you are not producing any goods? I would except for the amount of money that is being spent and what is being said this afternoon you should be able to say to me, this policy certainly did not work, or it was not working and we gleaned that and we were able to inform ministers that this policy was not working. Can I take the example of poll tax, that did not need a genius to set up a policy unit to work out that was not working, everyone knew it was not working and it was stopped. Give me some more examples, and if you cannot say you cannot and we will move on?
(Mavis McDonald) We do not hold a central registry in the Cabinet Office of what is working and what is not working. Departments are responsible for their own policies. The process whereby the questions are asked as to what is working and what is not working is the PSA and PSX acknowledging process.
84. The title says, "Ensuring Policies Deliver Value for Money". If you cannot tell me the policies that are not working how can they deliver value for money if we do not know the ones that are not working?
(Mavis McDonald) The process of policy change and shifting away from current policies to new policies does not just rely on the analysis we are doing here, which is designed to promote best practice, it relies on the underlying spending framework and it relies on what happens in ministerial priorities and political priorities for a Government, and whether they want to shift, and the way they set those out in things like their manifestos and whether they choose to move from certain approaches to other approaches.
85. I was coming on to that.
(Mavis McDonald) Within our own departments we can have examples of where those kind of changes have been taking place and might take place.
86. When I was leader of the local authority I used to ask chief officers to report to me on a regular basis policies that were working from our manifesto commitments and ones that were not. They would meet me and my colleagues and say, "we have developed this particular policy so far but it is not actually working", or "it is working, and we can do something about it". You cannot tell me that is happening in government?
(Mavis McDonald) I can give you various examples.
87. Let me tell you something else, sometimes policies did not work because the officers did not want them to work, how often does that happen in the Civil Service?
(Mavis McDonald) I do not think you really expect me to answer that question.
88. The minister told me he had great difficulty implementing some of these policies because the accounting officer was obstructive. Does that go on?
(Mavis McDonald) Accounting officers have particular responsibilities in relation to value for money, which you know more about than I do, so I can imagine circumstances in which accounting officers might give advice that ministers do not want. Basically departments are there to work with ministers to ensure that their priorities are put into practice. There are lots of examples of where policies have changed, I can quote you some from my own area, but what I cannot do is give you an across Whitehall-wide resume. I can talk to you about the processes where they might be identified. If you want to pick up on one, which is one we looked at last time, rough sleepers, I was engaged in that in the early 1990s, and I worked with Louise when she first came in. We changed the approach to rough sleepers because we started off simply providing housing for them on the assumption if they had somewhere to live their problems would be solved. It was quite clear that that was not working, the numbers were not going down, the problem was a throughput, not a static one, and a range of different policies were developed which was about dealing with the whole problem of people.
89. That is what I am asking about.
(Mavis McDonald) The single regeneration project that worked in deprived areas, there was a lot of money which went in, it had some very good successful physical results on the ground, but it did not change the nature of the area. Full evaluation was done of that which showed that, we did not engage local people in identifying what they really wanted, you did not get any follow through, so the physical improvements were done and everybody walked away who had been there to put the physical improvements together, and the place itself did not change. You needed to focus on a much wider range of issues relating to people, but within very small areas you could not handle some of the big economic issues which might be round declining industry in a wider area, so you had to have economic development policy which complemented regeneration policies in deprived areas. These are the kind of proposals that are now being followed through, whereby the Neighbourhood Renewal Unit approach to policy is complemented by the broader approaches to economic development from the Regional Development Agencies. The whole process of changing, shifting and developing goes on all of the time but it has a very strong ministerial input, it is not just civil servants who are driving it.
90. Absolutely. There was a question I was going to ask, I might as well put it in now, how often do you take notice of politicians, not just the ministers? How often do you take notice of ordinary back bench MPs who point out that things are not working? My experience is that they do not take any notice at all.
(Mavis McDonald) My answer is all the time.
91. It is not the politicians who answer your letters.
(Mavis McDonald) No, but it is the politicians who accept the answer. In my experience they do not sign letters that they are not prepared to sign.
92. You failed to answer what was to me a fundamental question that Mr Bacon asked you. I think he wanted to know about policies that were terminated because it had become clear that they were not working and you could not give him one example. I find that incredible. I cannot understand what the system is there for if you cannot give one example of where a policy is failing and it has been terminated. That is what you are there for. That is what the whole system has been put in place for, yet you could not give one example, so what use is it?
(Mavis McDonald) I think terminating is a very final word and it sounds like you are walking away from the policy.
(Mavis McDonald) You may be walking away from the policy but quite often you are still having to deal with the issues that you are dealing with. The way in which the report was phrased implies you have got to stop things but if you have got a policy that is not working but you have still got a problem you have not solved, what you have to do is develop a different policy approach to deal with the same issue.
94. On page 56, paragraph 3.24 it actually says "They said that policy reviews and formal evaluations very rarely resulted in a decision to terminate policies that were no longer effective." That means that policies that are not actually working, are no longer working, costing millions of pounds, are not terminated. Why?
(Mavis McDonald) I think you quoted one yourself which was palpably not working and which there was a political decision to walk away from by the then Government.
95. It did not need the huge organisation that has been put in place here costing, what is it, £400 million a year. That is what it says in the report, it is costing £400 million a year to run these policy scrutiny units. It did not need that to tell you that particular policy was failing miserably. My argument is that millions of pounds are being spent and you are not showing anything for it, are you, because I would have thought if £400 million was spent, to be cost-effective you should save the taxpayer over that £400 million that is being used to try to find the policies that are not actually working and, as far as I can see, it is not doing that.
(Mavis McDonald) I think we are misunder-standing each other here.
(Mavis McDonald) I think policy is shifting and changing all the time and it is being evaluated all the time, it is being measured all the time. You get better systems now for performance measurement in indicators to assess what we are really achieving in terms of real world outcomes. There are frameworks for scrutiny of departments and what they are achieving. The way in which policy moves on does not necessarily mean you terminate dealing with a particular issue if you have not solved the issue. You might draw back from one approach to handling it, and I gave you some examples, to develop another approach. That seems to me a perfectly proper and cost effective way of proceeding. There are occasions when things are actually stopped, but they are not that frequently actually stopped because you are usually operating within an area where there is a ministerial policy interest, there is a commitment of some kind to address an issue, there is quite often a European framework in which you have to keep moving forward.
97. The point I am making is if in 1990 or 1989, whenever it was, somebody had come along to the then Prime Minister and said, giving the example again of the poll tax, that it was not working, it was so unpopular it was unbelievable and gave advice at that particular time then such a lot of hassle could have been avoided. . .
Mr Williams: Or a job would have been lost.
Mr Steinberg: You are saying that is not what you are there to do, that is not what the system is there to do, the system is there to say how you can improve it.
(Mavis McDonald) I am not arguing that at all. I am arguing that where the evidence is that you should stop doing something you should stop doing something, but it does not mean that you walk away from the issue. You might stop a policy because it is not working but if you have still got to address the issue then you are going to have to move on and really develop another approach to the policy to address the issue. Presumably mostly you fail with policy because you have not solved the problem you set it up to deal with.
98. I am going to start with a few questions to Dr Salisbury, if I may. Dr Salisbury, I should warn you in advance that my wife is a GP, which I always declare on these occasions, although I have to tell you that none of the questions that I am about to ask you have anything to do with her or result from anything I have said to her or heard from her, they are from other sources. Having got that point clear, there are occasions throughout this Report when it is made clear that the Civil Service now believes, I think quite rightly, in the importance of consultation with front line staff, people who are actually going to implement any policy. Before you start to get the policy put together you want to find out whether it is implementable, I guess. So when you are trying to implement policies on vaccination, how do you consult with the GPs?
(Dr Salisbury) We have representatives from the Royal College of General Practitioners who attend our Joint Committee on Vaccination and Immunisation. We also work closely with individual GPs from the RCGP and we work with the British Medical Association. We will discuss in advance of implementing a new programme about the do-ability at individual practitioner level. Not all of our programmes are implemented through general practitioners, we also implement programmes through school health services and there we would be taking advice from people who are working in community child health and from nurses who work in that service.
99. So you consult with some of the representatives of GPs when you are trying to introduce a GP policy of some form. How much warning do you give the other GPs, the ones who have not directly been consulted about the introduction of a new policy?
(Dr Salisbury) That will depend very much on what the policy is, what the lead-in time is and what the operational necessity is to move. In some cases we will be alerting the profession three months, six months in advance. We have immunisation co-ordinators in every single health district and we try to make sure that they are brought into both the consultation process and the implementation process so that in every health district there will be one person who has got the training materials for primary care in particular in advance of a new programme. Sometimes that interval may be fairly short. If there is an imperative, such as the winter season of meningo-coccal disease, then we would want to move fast because moving slowly with a long lead-in time means that you may not be actually implementing what you are doing until after the winter season is over.