Solving the NHS productivity puzzle

The issue of NHS productivity has again been raised as an area of concern by the government, the mainstream press and Lord Ara Darzi’s 2024 report on his investigation into NHS performance (i.e. the ability of the NHS to meet government targets). The ‘productivity puzzle’ refers to the perception that increased investment in the NHS is not being met by an equivalent increase in productivity (i.e. number of patients treated per unit cost). A significant reason for this observation appears to be a failure to recognise that much of the funded increase in NHS activity over recent years has been directed at improving safety and quality (rather than quantity) in a way that is simply not being captured or recorded by those tasked with calculating productivity. This paper illustrates that there has been a greater than 500% increase in the number of steps involved in a simple surgical pathway today compared with 20 years ago (from 46 to 265 steps). This increase in activity improves safety and quality but inevitably takes time to deliver, resulting in fewer patients being treated in the time available. Despite adding value, this important activity is not reflected in NHS productivity figures (hence the perceived ‘productivity puzzle’). The author discusses the reasons for this and tries to make the case for factoring quality into productivity calculations. This would mean that activity that adds value to what we do in the NHS is acknowledged rather than perceived as waste or inefficiency.