A major report has found that the NHS in England could prevent between 18,500 and 20,600 deaths annually from treatable causes and deliver 2.5 to 4.5 additional years of good health on average for people, if it reduces bureaucratic burden and increases operational efficiency without requiring extra funding.
Research by the Health Foundation identified excessive regulation, short-term planning and limited capacity for major change as longstanding obstacles to the health service's performance. The analysis suggests that by redesigning how the NHS operates—through harnessing technology, empowering clinical and support staff, and increasing capital investment—the system could simultaneously save lives and unlock £33bn in annual savings.
"Our analysis suggests that if the NHS in England achieved outcomes closer to the best-performing comparable health systems, without spending more each year, it could potentially result in 18,500–20,600 fewer deaths each year from treatable causes and 2.5 to 4.5 additional years that people spend in good health on average,"the report stated.
Where could deaths be prevented?
Early cancer diagnosis and faster identification of people with high blood pressure, diabetes and similar chronic conditions would be critical priorities. The report emphasised that substantial improvements in health outcomes are achievable within the funding already allocated to the NHS, challenging the assumption that better results require additional spending.
What changes does the report recommend?
The Health Foundation called for the NHS to be released from unnecessary regulatory, reporting and compliance requirements that consume clinical time without improving patient care. The report also advocated for a "test-and-learn" approach to scaling innovations that could boost productivity, including wider deployment of artificial intelligence in diagnosis and treatment planning.
However, the report acknowledged that while AI presents significant opportunities,
"the NHS has repeatedly struggled to take advantage of the potential."
Researchers identified three major productivity drains: constant organisational churn, excessive performance targets that distract from health outcomes, and insufficient focus on what actually matters to patients. Staff interviews revealed that outdated IT systems wasted valuable clinical time, inadequate facilities and equipment limited care quality, and gaps in administrative support forced clinicians to handle non-clinical tasks.
How does productivity improvement differ from simply working harder?
The report pushed back against the perception that productivity gains mean demanding more effort from already stretched staff.
"At its heart, productivity means achieving better health outcomes from the resources available."This reframing emphasises efficiency and redesign rather than intensification of effort.
Anita Charlesworth, the report's author and senior economic adviser at the Health Foundation, said:
"This is mission critical for the NHS, which cannot simply keep doing more of the same. The problem is not a lack of committed and talented people or an absence of ideas; it is that the NHS is not set up to deliver sustained productivity growth. Our research points to a fundamental redesign of the operating conditions – not another disruptive reorganisation, but a reset to make improving productivity a defining focus for the NHS over the next decade and beyond."
What is the current state of NHS productivity?
Recent data shows mixed progress. According to NHS England's latest annual report, acute provider productivity improved by 2.8% in 2025/26, with productivity across all trusts rising 3.4% when outliers are excluded. The service has sustained delivery above the 2% productivity target over the past 18 months, including 2.7% improvement in 2024/25 and 2.6% in acute hospitals in the first half of 2025/26.
However, a separate analysis found that NHS acute hospital trusts were around 14% less efficient in 2024/25 than in 2018/19, with inputs rising 30% while outputs increased only 12%. Additionally, an updated independent investigation found hospital productivity is at least 11.4% lower than in 2019.
The Health Foundation has previously highlighted that NHS productivity fell sharply during the pandemic and remains below its pre-COVID trend, with an estimated roughly £20bn shortfall in cumulative output.
What do NHS leaders say?
Sir Ciarán Devane, chief executive of the NHS Alliance, which represents and supports the health and care system in England, Wales and Northern Ireland, acknowledged that further productivity gains are possible but warned of significant barriers.
"Lack of capital investment has been a long-running drag on NHS productivity. More must be done to turn the tide on years of neglect … We also agree that a more streamlined, supportive regulatory system which encourages local autonomy and innovation will be vital for future progress."
What happens next?
NHS England began publishing trust-level productivity growth statistics from 12 February 2026, with monthly updates continuing thereafter. The service has committed to ongoing transparency on productivity performance, with final revised estimates for earlier 2025/26 periods scheduled according to its methodology timetable, including revisions published from 13 August 2026. The NHS Productivity Commission's work will continue to frame future reform around workforce, capital, technology and transformation.
Key Facts
- The Health Foundation estimates 18,500–20,600 preventable deaths annually if the NHS matched comparable health systems' outcomes without additional spending
- Acute provider productivity rose 2.8% in 2025/26, but hospital efficiency remains 11.4% to 14% below pre-pandemic levels
- The report calls for regulatory reform, a test-and-learn approach to innovation, and better use of technology rather than additional funding
- NHS England is now publishing monthly trust-level productivity statistics to improve transparency and accountability
- Capital investment shortfalls and excessive bureaucracy are identified as the primary obstacles to sustained productivity growth
