On Thursday 12 February, NHS England published the first tranche of new productivity measures for NHS trusts. The measure, which has been in development for over a year, is experimental rather than perfect. Community and mental health members in particular are concerned about how block contracts have made it incredibly difficult to untangle and analyse the activity within the system in sophisticated way.
But, for the time being, it's the best data we have to measure productivity across the NHS as close to real-time as possible.
Secretary of state Wes Streeting commissioned these localised measures as part of his commitment to hold NHS managers to account. Nationally, acute sector productivity growth reached 2.6% over the first half of this financial year. This is well above historic levels. Trusts are clearly responding to the clear and high expectations set for them by NHS England chief executive Sir Jim Mackey. But the data should never be mistaken for the destination. Productivity is a long-term endeavour, shaped by decisions about capital, workforce, technology and system design whose effects unfold over years, not quarters.
This is why the NHS Confederation, alongside NHS Providers (now a merged legal entity with a new brand and name coming in April), and sector partners have consistently argued for sustained capital investment and the use of public private partnerships to fund this.
Productivity does not improve in a vacuum. It requires modern facilities, interoperable digital systems and technology that enhances care pathways rather than operating as isolated add-ons. Without the right infrastructure, even the most motivated workforce, from trust chief executive to frontline clinician, cannot deliver the gains ministers want to see.
But workforce is central to improving productivity, not only in terms of numbers, but in capability, confidence and culture. Staff need the time and support to train to use new technologies in their work. They need to feel empowered to innovate and trusted to make decisions. They need to feel their work is meaningful. Productivity is not something that can be squeezed out of people; it emerges when colleagues are enabled to do their best work.
How the new local productivity data is used will determine whether it drives genuine reform or simply fuels another cycle of system pressure. Productivity figures are not a verdict on effort. They reflect the resources, infrastructure, governance, payment mechanisms and people that shape care. Treating the new data as a narrow performance metric is unhelpful.
In a recent speech at the Institute for Government's annual conference, the secretary of state framed productivity almost exclusively as something to be ‘unleashed by technology'. He set out five principles for modernising the NHS – the others, aside from technology being: power to the people; freedom for the frontline with accountability; a shift from crisis response to prevention; and careful stewardship of taxpayers' money. I would argue that all five are productivity principles. They are about creating the conditions in which better care becomes possible and then improved productivity follows.
Just over a year ago, I interviewed two NHS leaders for our improvement podcast, produced in partnership with the Q community. Both had achieved significant productivity improvements in their local systems. Yet neither had set out to improve productivity. Their aim was to improve care.
By redesigning pathways, engaging patients and carers, and working closely with staff, they created better services. The productivity gains emerged as a byproduct. In both examples, relationships – between leadership and frontline staff, staff and patients, were central, and time and space was given to listening and understanding the experience of patients, their families and carers.
Their experience underscores a truth the system and the centre often forgets. Productivity is the outcome of doing the right things well, not of pushing harder on isolated targets.
The new local productivity data is a useful tool, but only if it is used to understand what enables good care rather than to apportion blame.
Productivity improves when care improves. That is the lesson from local leaders, from years of evidence and from the lived reality of staff and patients. The sooner political leaders and national policy reflects this, the sooner the NHS will deliver the sustainable improvements everyone wants to see.
