Intended for healthcare professionals


Measuring NHS productivity

BMJ 2005; 330 doi: (Published 28 April 2005) Cite this as: BMJ 2005;330:975
  1. Donald M Berwick, president (
  1. Institute for Healthcare Improvement, 20 University Road, Cambridge MA 02138, USA

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

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

    The job of the health service is to produce health—to relieve suffering. In the words of National Academy of Sciences in the United States, “The purpose of the health care system is to reduce continually the burden of illness, injury, and disability, and to improve the health status and function of the people…”2 Ideally, the term productivity, as applied to the 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, injury, and disability …

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