Intended for healthcare professionals


Does the NHS have a productivity problem?

BMJ 2024; 384 doi: (Published 25 January 2024) Cite this as: BMJ 2024;384:q130
  1. Richard Vize, public policy journalist and analyst
  1. richard.vize{at}

With the NHS getting more staff and money for little measurable improvement in patient care, there are concerns that the health service has a productivity problem. Does it, asks Richard Vize—and, if so, why?

Health service productivity matters for the whole economy. Healthcare spending, both governmental and non-governmental, consumed 11.3% of gross domestic product in 2022, compared with 6.8% in 1997.1 NHS effectiveness has a big impact on the overall productivity of public services, perceptions of value for money for taxpayers, and the ability of the NHS to help people to be fit for work.

In evidence to the health select committee in November, NHS England chief executive Amanda Prichard dismissed current productivity measures as “a fairly blunt tool” and said there was a “misunderstanding” about NHS productivity, because the figures do not fully reflect activity such as critical care, diagnostics, community services, and virtual wards, or quality improvements such as the recent £165m investment in maternity staffing.2

Healthcare data scientist Steve Black describes the idea that there is not a significant problem as “absolutely ludicrous, given the past three or four years of NHS history.” He highlights analysis by the Institute for Fiscal Studies showing that over the past four years the numbers of consultants, junior doctors, nurses, health visitors, and support staff grew between 15.8% and 24.6%, while treatment volumes in emergency and non-emergency admissions went down, and outpatient appointments and the waiting list barely moved.

Hospital staffing and treatment volumes in 2023 compared with 2019. Source: Institute for Fiscal Studies3

“We’ve got vast amounts more staff and more money but output is unmoved,” Black says. “The leadership is in denial that there is a serious problem.”

Total Department of Health and Social Care spending increased from £158bn in 2019-20 to £182bn in …

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