In this Viewpoint article, Nick Black from the Department of Public Health and Policy at the London School of Hygiene and Tropical Medicine in London argues that the productivity of the NHS has probably improved over the past decade, despite claims by the Secretary of State that there has been a “15% reduction in productivity”, and looks at how the ‘myth of declining productivity’ came about.
The author discusses the shortcomings of the main evidence cited by politicians for a productivity decline, including concerns over the estimation of the quantity and quality of outputs. He notes that quality was assessed using three dimensions (safety, effectiveness and experience) and there are concerns as to the relative importance ascribed to each, including why patient experience only contributes to 2.5% overall of the overall quality assessment. Other concerns with the data are discussed.
The author goes on to discuss other data which suggest that there have been substantial improvements in the quality of health care, evidence-based clinical practice and patient experience. Although these are subject to some uncertainty, they note that even a 1.3% a year improvement in quality would have changed the judgement that NHS productivity fell to a verdict that it rose between 2000 and 2009. Therefore they ask “why has a judgment with such an uncertain basis been so widely accepted as a fact?”
They conclude that: “Declining NHS productivity in England between 2000 and 2009 is just one recent myth in health-care policy. Many other myths have arisen in the past and many more will do so in the future. We cannot prevent myths developing but we should remain vigilant, spot them as early as possible, and attempt to minimise the harm they can do in distorting understanding and misleading policy makers. Meanwhile, development of accurate and competing estimates of health-care productivity are needed that make use of the burgeoning array of high-quality data and that translate improvements in quality into generic measures, such as quality-adjusted life-years.”