More money and staff – why isn’t the NHS more productive?

This productivity puzzle – as the Institute for Government (IfG) calls it – has been a cause of concern at the heart of government for some time.

During an election debate in front of health leaders last month, a candid Lord Bethell, who served as a health minister in the last government, said the Treasury had become “sick to death” of pouring money into the health service only to see productivity fail to improve: “They [the Treasury] believe the return on investment is terrible.”

But it is not just in the corridors of Westminster that the perception has developed. The public is also concerned, according to Anna Quigley, research director at Ipsos UK: “Generally around eight in 10 say they are willing to pay more tax to fund the NHS. But they also say it needs to make changes – cut out waste and inefficiency.”

The temptation is to assume it was the pandemic that threw a spanner in the works – after all it led to a dramatic fall in treatments being done, and the waiting list to balloon. Could it be that the NHS is still recovering from the shock of that?

The IfG analysis, external of the problem published last year suggests not.

Focusing on treatments is just one rather blunt mark of productivity, so the IfG looked at a range of different measures – and found the NHS actually started to become less productive in the late 2010s after about 15 years of improving productivity.

It was clear, the IfG concluded, the pandemic may have pulled the trigger, but the gun was loaded well before Covid struck.

The Nuffield Trust has come to a similar conclusion in an analysis published this week, external, pointing out the NHS has struggled more than other countries, such as Finland and Spain, to get waiting times down since the peak of the pandemic.

It’s director of research Sarah Scobie says the new government faces an “enormous uphill battle” to get the NHS back on track.