“To fulfil its constitution, the NHS must continue to provide a comprehensive, excellent service, available to all”, says report

Underground station sign saying mind the gap

The NHS faces an increasing funding gap and a conflict between supply and demand. The constitution says that the NHS must provide a high quality service for everyone. However, the population is growing, and people are living longer, so how can the NHS continue to do more with less? Monitor believes that getting better “health value” by increasing productivity is achievable and the best plan for reducing the funding issues. However, this does not mean that they are expecting NHS staff to work longer, but to work more efficiently, so that they are delivering the same quality service, but with fewer or the same resources.

Signpost saying time, cost, and quality

Savings can be made by working more efficiently

Evidence-based practice

There is lots of evidence of varying quality, describing ways to improve productivity in health care. Monitor have gathered the best evidence to help decision-makers identify the most effective way of improving productivity in their own organisations. They have identified four ways that organisations can increase productivity:

  1. Improving productivity within existing services
  2. Delivering the right care in the right setting
  3. Developing new ways of delivering care
  4. Allocating spending more rationally

This report is aimed at commissioners, decision-makers, finance departments, economists, and politicians. It takes each of the above opportunities and describes in great detail the amount of savings that can be made by working more efficiently, and the case studies put their solutions into context, demonstrating how achievable these activities are. The report also looks at how to manage non-recurrent savings, such as wages and capital. It concludes by emphasising how important it is for NHS staff, politicians, and the public to work together so that new ways of delivering health care in England can be developed.

Green highlighter pen highlighting the word worth

Getting better “health value” by increasing productivity is achievable


This is a really useful document, because it spells out what needs to be done and explains how it can be done. There are examples of how much money can be saved and case studies to illustrate the point. Organisations should read this report and see if any of the opportunities described above can be translated into their own situations so that patient care is improved while savings are being made.


Closing the NHS funding gap: how to get better value health care for patients (PDF)
October 2013

Supporting material

Improvement opportunities in the NHS (PDF)
June 2013

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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