Reducing variations in NHS productivity would in some cases require more investment in services rather than less, the King’s Fund has suggested.

The McKinsey report highlighted a range of potential areas for saving money, from staff cuts to increasing productivity.

My suspicion is that it will depend on how much whoever is in power will spend on the NHS

John Appleby

King’s Fund chief economist on health policy John Appleby said variations in service productivity, such as length of patient stay, were “worth looking at in more detail”.

But he said it would be hard to reduce this variation universally and reduction might have to be tackled case by case.

Some cases might need upfront investment to make the changes required to reduce productivity variations long term.

“The question is undoubtedly: why we have that variation in the first place and what it would cost to reduce it,” he told HSJ.

Professor Appleby also asked how McKinsey’s had come up with the case for a “dramatic” 10 per cent reduction in the NHS workforce.

Professor Appleby said that based on previous research into the current NHS funding dilemma carried out jointly by the King’s Fund and the Institute for Fiscal Studies “nowhere is there a necessity to cut jobs”.

But he agreed with McKinsey that an increase in income could come from selling off NHS land and that commissioners might look at cutting some services, such as tattoo removal and some fertility services.

“Maybe primary care trusts are looking at stopping doing things that are considered cost effective at the moment,” he said, adding that PCTs might also get much tougher about following National Institute for Health and Clinical Excellence rulings on costly treatments.

However, Professor Appleby said the true extent of the savings needed was not yet known.

“My suspicion is that it will depend on how much whoever is in power will spend on the NHS,” he said.

He cited the Conservatives’ recent promise to keep to a “real rise” in NHS funding, should they win the next election.

“Great, but where’s it going to come from?” he asked.