Benchmarking in UK health: a gap between policy and practice?

Purpose – This paper aims to bring greater clarity to the debate on the merits (or demerits) of relative performance evaluation through a broad assessment of current UK National Health Service (NHS) benchmarking. It seeks to examine whether benchmarking is being used dynamically to disseminate best practice in healthcare, or whether it is primarily a government tool to enforce static competitive performance standards. Design/methodology/approach – Draws on recent literature and government pronouncements. It charts the development of the health care policy discourse that articulated a move from the internal market of the early 1990s to the metrics approach of New Labour. Findings – Benchmarking is one of the private sector‐grown “managerialist” tools whose application and significance is rapidly increasing in the UK public sector. Despite its prevalence, the nature (competitive or comparative), the process (based on indicators or ideas) and the outcomes (standards or “best practice”) of benchmarking in public services remain unclear. The findings reveal that benchmarking requirements, imposed by government policy, are articulated in terms of comparative ideas – benchmarking with the stated objective of “sharing best practice”, but are operationalised and disseminated in the form of indicator league tables with standardised benchmarks for performance. Hence, there is an apparent “articulated policy – implemented practice gap”. Concludes that, whilst benchmarking is a highly desirable policy instrument, its practical relevance to health care improvement is still in doubt. Originality/value – The findings are relevant to both NHS policy‐makers and to NHS actors who must engage with the processes and outcomes of benchmarking practices.