In the 1950s, the Ministry of Health, supported by interested groups outside government, recognised the political importance of productive efficiency. For leadership, organisational models and techniques the Ministry looked to the movement for industrial productivity. The NHS was receptive, but private-sector approaches were modified and dampened as they were imported. NHS management was to be the provider of technical expertise, but the deployment of this expertise was limited by clinical autonomy and de-coupling from financial incentives. This article casts new light on the history of productivity policy, NHS management and the moving frontier between state and civil society.