Growing the Productivity of Government Services

Growing the Productivity of Government Services

Patrick Dunleavy and Leandro Carrera

Productivity is essentially the ratio of an organization’s outputs divided by its inputs. For many years it was treated as always being static in government agencies. In fact productivity in government services should be rising rapidly as a result of digital changes and new management approaches, and it has done so in some agencies. However, Dunleavy and Carrera show for the first time how complex are the factors affecting productivity growth in government organizations – especially management practices, use of IT, organizational culture, strategic mis-decisions and political and policy churn.

Chapter 8: Hospital productivity in England’s National Health Service

Patrick Dunleavy and Leandro Carrera

Subjects: economics and finance, public finance, public sector economics, politics and public policy, public policy, social policy and sociology, comparative social policy


The National Health Service in England is one of the largest connected sets of public sector organizations in Europe, and on a par with the provincially run and more mixed health systems in large countries such as China and India. The vast bulk of NHS activivites (69 per cent of the output index in 2007–08) is made up of hospital and community health services (Peñaloza et al., 2010, p. 6). Most trusts operate just one or two hospitals, and hospital sizes vary from smaller ‘district general hospitals’ for a single city or area, through to large, multi- specialism hospitals in regional metropolitan areas and in Central London. In this chapter we explore in detail what influences seem to shape the overall productivity of the acute hospital trusts in England. We begin by setting the scene, looking at successive governments’ attempts to boost the efficiency of NHS hospitals by introducing elements of competition to attract patients between hospitals, interspersed with other periods where policy stressed more the integration of services and the stabilization of hospital budgets in a more predictable fashion.

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