The comprehensive spending review is no longer the distant event it once seemed - the coming financial squeeze makes a numbers game out of the next 18 months or so.

The comprehensive spending review is no longer the distant event it once seemed - the coming financial squeeze makes a numbers game out of the next 18 months or so.

That is why the 'Better Care, Better Value' indicators have the potential to be so important. They are the single most important thing the National Institute for Innovation and Improvement has done since it was created.

But the indicators - or trusts' relative position on the performance table - do not in themselves help them 'identify and share best practice', as the Department of Health claims. And it would be a tragedy if managers were forced, or forced themselves, to chase a number without any context.

As Helen Bevan of the NHSIII has argued, too much 'efficiency' work in the NHS is about trying to do a lot more or a lot less of essentially the same thing rather than genuinely reworking processes.

It is finding the stories behind the numbers that matters. What is it about University Hospitals of Leicester trust that means it apparently has almost£30m worth of resources it could free up?

What caused the gulf between North Bradford and North Liverpool primary care trusts in their ability to manage variations in emergency admissions?

And not all the indicators are always useful - a specialist cancer hospital like Christie will baulk about being labelled inefficient because of its low day-case rate.

However, variation is a tricky beast. It is by no means the case that all variation from a norm denotes an inherently inefficient process.

A genuinely effective clinical system should be able to flex itself; otherwise the inefficiencies are just transferred and pop up in other, unsupervised areas.

More information

Click on the link below for full lists of organisations performance against the efficiency indicators:

http://www.productivity.nhs.uk