The next British general election will probably be fought over the productivity of public services. Opposition parties have already claimed that the unprecedented extra investment in the NHS has been misspent, with medical staff receiving large increases in pay for doing the same, or even less, work. Although an election may be four years away, the government is seeking evidence to show that, contrary to such claims, the extra resources together with organisational reform have increased productivity in the NHS.

This quest is also being driven by an international requirement for governments to measure output from the public sector and by the Department of Health's need to justify its demands to the Treasury for further increases in resources.1 In the political battle that has already started, both government and opposition parties will make claims and counterclaims as to how the productivity of the NHS in the United Kingdom has changed in recent years. So what impact have the extra funds had on productivity?

Until recently, attempts to measure productivity were limited to relating the level of activity in the NHS (such as numbers of consultations and hospital admissions) to the …