An extremely interesting paper in The Lancet by Professor Nick Black suggests that the much-discussed decline in NHS productivity since the 2000 funding increases is, not to put too fine a point on it, not the case.

This matters hugely, as declining productivity is one of the key stated reasons behind the Health and Social Care Bill.

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Black suggests that "rather than declining, the productivity of the NHS has probably improved over the past decade. So how has the myth of declining productivity come about?

"The main evidence cited by politicians was published in December, 2010, by the National Audit Office, which claimed that hospital productivity had declined by around 1·4% a year. This conclusion relied on an analysis done by the Office for National Statistics (ONS), which showed that overall NHS productivity in the UK declined by 0·4% a year since 2000".

He suggests that the ONS analysis is based on too narrow a range of metrics - number of hospital admissions and out-patient attendances, number of consultations in primary care, and number of prescriptions dispensed - which fail to capture key kinds of productivity improvement.

Black also queries the methodology of quality metrics used, asking pertinently "why does patient experience contribute only 2·5% to the overall assessment of quality?" He notes that "the assessment of health gain relied on data from privately funded patients who reported substantially less benefit than did NHS patients (for example, a hip replacement was assumed to result in a 68% increase in quality of life whereas recent data on NHS patients showed 153% improvement".

Black cites a broad range of quality and patient experience improvements. He admits that "all these data are subject to some uncertainty (eg, some deliberate distortion of data might have occurred) and could overestimate the change in quality that took place, the diversity and size of the annual relative improvements suggest that a 0·8% a year adjustment for improvement in quality is insufficient".

He concludes, "declining NHS productivity in England between 2000 and 2009 is just one recent myth in healthcare policy".