I used to work with a (now retired) professor of public health medicine who was an expert on measuring and acting on clinical effectiveness findings. He used to argue strongly that if there was no clear evidence of the effectiveness of a particular clinical activity then the NHS should not be providing it from taxpayer’s funds. If people wanted to pay for it privately then that was up to them. Perhaps the best examples here are the so-called complementary therapies.
Note that the thrust of his view was that the onus was for the supporters of the activity to prove (beyond reasonable doubt) that the activity was effective not for the sceptics of the service being forced to prove that it wasn’t effective (which is, of course, an impossible task). If this approach was followed completely down the line then the likelihood would be that vast swathes of NHS activity might be curtailed, but that is another story.
These thoughts came back to me when reading the debate over the merits of curtailing Child Benefit for higher-rate taxpayers. One of the objections being made was that the way it was being approached would provide a strong financial disincentive to mothers who wanted to stay at home to look after their children as opposed to going out to work. I did a quick review of the research literature on stay-at-home mothers versus working mothers, and the impact on their children and I came away with two broad conclusions:
- The issue about the merits of working mothers versus stay-at-home mothers is hugely complex with a wide range of variables at play including: the age of the children, the timing of the return to work, the scale of the work and the educational background of the parents
- There is no proof (beyond reasonable doubt) that the children of stay-at-home mothers do better on outcomes than the children of working mothers when looking across the board
Going back to my professor and his views on clinical effectiveness, why therefore should the state be providing financial incentives for mothers to stay at home if there is no clear proof that it produces benefits? Surely this is a private choice for individual families taking account of personal issues and circumstances and not one which should worry politicians or put burdens on the national exchequer.
Maybe if we applied these evidential tests more rigorously to public spending we wouldn’t have the size of budget deficit we do have,
Malcolm Prowle is professor of business performance at Nottingham Business School and a visiting professor at the Open University Business School. He can be contacted via his web page www.malcolmprowle.com
