jats:pMeasured health output in the UK declined sharply during the Covid-19 pandemic, despite the evident large increase in some National Health Service (NHS) activities such as critical care, and the new test and trace and vaccination programmes. We explain the measurement methods applied to public services that produced the published decline, in the context of the inherent difficulties of defining and measuring health output and productivity; and describe the changes in practice that had to take place in NHS hospitals. We also discuss, on the basis of these changes including increased use of technology, the likely outlook for healthcare productivity. We conclude that within NHS England capacity, constraints have contributed to substantial falls in non-Covid-19 healthcare output and argue that increased capacity in the social infrastructure of the health service is essential to enable higher productivity in an uncertain environment.</jats:p>