Abstract
Competition from private sector providers is only one of a number of factors which are stimulating the NHS to increase productivity. Patient choice, stronger commissioning and payment by results are likely to be very strong drivers for improvement. The provision of services in the NHS of tomorrow will be largely in the hands of foundation trusts, which will need to be able to offer services that are attractive to patients and are within the care pathways set-out by commissioning primary care trusts. Fundamentally, they will need to ensure that overall their services are within the tariff price if they are to remain in business. The private healthcare sector, whether through the independent treatment centre system or as competitors for the provision of other services, will put additional pressure on NHS providers. However, private sector providers will also face the same challenges of strong commissioning and fixed tariff prices and will face productivity pressures of their own. The need to increase productivity within the NHS is widely acknowledged and some organisations are adapting process engineering from the manufacturing sector, but there is no easy solution. Increased productivity will require leadership and vision.
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