Far from being on a steady slope downward it seems that National Health Service productivity may have actually been on the rise in recent years, suggests an article in The Lancet.

In a direct contradiction of claims that NHS productivity has fallen over the last decade - a central vein of the government's argument for the current dramatic healthcare reforms - Professor Nick Black, from the Department from Public Health and Policy at the London School of Hygiene and Tropical Medicine, argues that the figures fail to reflect real improvements achieved by the health service during this time.

Analysis by the Office for National Statistics frequently cited by politicians to highlight the need for change has shown that overall NHS productivity in the UK slipped 0·4% a year since 2000. However, quantity estimates were based on just 80% of activities, thereby potentially underestimating service output, and there were concerns over the way improvements to service quality were assessed, casting a shadow of doubt over the report's conclusions.

A subsequent look at a much wider range of data now available actually suggest substantial improvements in the quality of healthcare, Prof Black says. For example, the life expectancy of a baby born in 2009 is three years longer than one born in 2000, while fatality rates from specialist databases provide further evidence, showing declines in adult critical care (2·4% a year), dialysis (3·3% a year), coronary artery bypass surgery (4·9% a year), and acute myocardial infarction (5·3% a year).

In addition, improvements in evidence-based clinical practice also underpin a higher quality service, with a relative rise of 11·0% a year for use of primary angioplasty after myocardial infarction with ST elevation, while adherence to guidelines for patients with stroke have risen 5·7% a year, he notes.

Kill the bill

The findings are particularly pertinent given that one of the reasons the current government cites for its "radical and widely unpopular health reforms" is the decade-long decline in productivity of the NHS, notes Lancet editor Richard Horton. But, "as Nick Black shows, this alleged decline is a myth." 

"If the main reason for the Health and Social Care Bill is a lie, the upheavals it will produce are entirely unnecessary. This is further evidence to kill this damaging and dangerous bill,” he added.

Shadow Health Secretary Andy Burnham said Prof Black's analysis is "hugely embarrassing" for Prime Minister David Cameron.

"It demolishes an anti-NHS argument that Cameron and his Ministers have repeatedly trotted out for their right-wing re-organisation. Far from falling, NHS productivity increased in the last decade at the same time as the NHS was achieving record patient satisfaction", he said.