Breaking the cycle. How to build a more productive NHS (September 2026)

Summary

Improving productivity will be critical if the NHS is to deliver better outcomes for patients and to reduce future spending pressures by almost 10% by 2040. This NHS Productivity Commission and Health Foundation report sets out the conditions needed to deliver change.

Content

Building an NHS that serves patients, the public and staff well – now and in the future – will depend on sustained productivity growth. At its heart, improving productivity means achieving better health outcomes within the available resources. 

Causal estimates are challenging, but analysis across 14 high-income countries suggests that if England matched its highest performing peers, this could result in improved outcomes within the existing budget. This could be equivalent to around 18,500–20,600 fewer treatable deaths each year, alongside people spending on average 2.5–4.5 additional years in good health.

The NHS has no shortage of talent and good ideas. Instead, its productivity challenges are rooted in short-term planning, fragmented accountability and an overly complex operating environment that makes sustained improvement difficult. This report sets out how policymakers and system leaders can create the conditions to help deliver the change needed. It makes ten key recommendations that include: 

• establishing a stable, 5-year planning and investment framework to support long-term productivity growth  

• creating a dedicated unit tasked with releasing the NHS from unnecessary regulation, reporting and compliance requirements 

• recognising the essential role played by NHS leaders, managers and staff by developing a workforce plan for non-clinical teams 

• establishing a national ‘test-and-learn’ approach to identify, evaluate and scale models of care and emerging technologies, including capabilities to evaluate, adopt and spread AI 

• strengthening the role of NHS regions and giving greater devolved freedom and responsibilities for improving NHS services and productivity locally. 

The NHS already has the people, resources and technology to be more productive, but it needs the right conditions to succeed. Many of these changes will take time to deliver, but a more productive NHS is within reach. The Commission’s report sets out the conditions needed to break the current cycle and deliver lasting change.