Digital Maturity and Technical Efficiency in NHS Acute Trusts: Cross-Sectional Evidence from England

Abstract

Whether investment in digital health technology is associated with differences in hospital productivity is a question of substantial policy relevance, yet interpretation is constrained by challenges in causal identification and prior evidence is mixed. Technical efficiency in NHS acute hospital trusts in England is estimated using Bayesian stochastic frontier analysis. A four-input Cobb--Douglas production function incorporating clinical full-time equivalents, administrative full-time equivalents, non-labour expenditure, and physical capital derived from audited NHS accounts is fitted to 111 acute non-specialist trusts in 2024/25. Digital maturity, measured by the NHS Digital Maturity Assessment, is included in a trust-specific inefficiency equation alongside population deprivation, teaching status, and financial position controls. The composite digital maturity score is estimated to be negatively associated with technical inefficiency (\(\hat{\gamma} = -0.612\), 95\% credible interval \([-1.289, +0.005]\), \(P(\gamma < 0) = 0.974\)). Trusts in the highest digital maturity quartile are estimated to operate at 98.0\% of their production frontier compared with 93.2\% for the lowest quartile. This gap corresponds to approximately \pounds 20 million of additional cost-weighted activity per trust at mean output levels, or \pounds 1.1 billion in aggregate. Estimates are robust to functional form but are sensitive to the most conservative prior specification. Pillar-level analysis suggests that population health management and care pathway optimisation domains exhibit stronger associations with efficiency than other domains. Catchment deprivation is not estimated to have an independent association with efficiency after controlling for digital maturity.