Measuring NHS productivity

doi:10.1136/bmj.330.7498.975

BMJ 2005;330:975-976 (30 April), doi:10.1136/bmj.330.7498.975

Editorial

Measuring NHS productivity

How much health for the pound, not how many events for the pound

The first 150 words of the full text of this article appear below.

The October 2004 report from the UK Office for National Statistics(ONS) invites potentially harmful misunderstandings.¹ The reportconcludes that NHS productivity declined by 3-8% (dependingon the method of calculation) between 1995 and 2003. "Productionof what?" is the key question here. If we ask the wrong questionthe answer may lead us to the wrong policy conclusion.

The job of the health service is to produce health—torelieve suffering. In the words of National Academy of Sciencesin the United States, "The purpose of the health care systemis to reduce continually the burden of illness, injury, anddisability, and to improve the health status and function ofthe people..."² Ideally, the term productivity, as applied tothe NHS, ought to refer to the ratio of inputs (such as labour,capital, and supplies) to that output, not just counts of activities.

Of course the burden of illness, . . . [Full text of this article]

Donald M Berwick, president

Institute for Healthcare Improvement, 20 University Road, Cambridge MA 02138, USA (dberwick@ihi.org)