Intended for healthcare professionals

Education And Debate Modernising the NHS

Performance and productivity

BMJ 2000; 320 doi: (Published 27 May 2000) Cite this as: BMJ 2000;320:1462
  1. Jennifer Dixon, health policy analyst (
  1. King's Fund, London W1M 0AN

    This is the third in a series of seven articles

    The government's vision for the NHS is of a “modern” service—one offering convenient access and prompt, high quality care responsive to patients, all delivered in a modern environment. The extra £19.4bn over the next five years will be a big help.1 But money of itself will not be nearly enough. To achieve anything like the “modern” vision, the NHS will need to shift up several gears in performance. And to raise the temperature, the largest enterprise in the United Kingdom has effectively been given until 2004 to improve. Who the judge will be at that point, and what the verdict will mean for the NHS, is not yet clear. What is clear is that improving performance must be the central concern in any national plan for the NHS. It is the unenviable task of a 20 member group, in three months, to come up with ideas to improve performance and productivity. What should these plans include?

    Summary points

    Performing well should mean improving quality, not simply productivity

    The government should make explicit whether the aim is to concentrate on poor performers or raise the performance of all

    The government should explore and develop the ways of motivating organisations, teams, and individuals to perform well, with incentives where necessary

    All approaches to improving performance should start from the perspective of patients—not politicians, professionals, or managers

    Reflect and clarify

    Firstly, the government should clarify and, ideally, justify its approach to improving performance. The past three years have been full of initiatives, based on different assumptions and targeted at different groups, by ministers with different apparent “styles” and language. All of this needs to be brought together and reflected on in the round before any new ideas are added. It might be that the existing package is …

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