Ahead of the NHS’s 70th birthday, a new IEA briefing highlights how the poor performance of the NHS is costing thousands of lives every year.

Available data shows that the NHS is an international laggard on many key measures including health outcomes, survival rates and waiting times. IEA research finds that if UK cancer patients were treated in Germany, rather than on the NHS, more than 12,000 lives would be saved each year. And more than 5,000 stroke patients would survive. In Belgium, more than 14,000 cancer patients would be saved each year.

While cash injections may help in the short term, they will prove to be a waste of taxpayers’ money if structural changes are not made alongside investment.

Far from celebrating the NHS this week, policymakers should be considering wholesale reform of the centralised system to improve patient care and save lives.

Hard truths about the NHS:

•    The NHS lags behind Western European countries for health outcomes. In international comparisons, the NHS almost always ranks in the bottom third – on a par with countries like the Czech Republic and Slovenia.

•   The NHS also lags behind social health insurance systems in Europe when looking at quality of care and efficiency.

•   Survival rates for the five most common types of cancer are well behind the best performing countries:

If patients were treated in Germany, instead of on the NHS, more than 12,000 lives would be saved each year

In Belgium, more than 14,000 lives would be saved each year

•    Survival rates for stroke patients also fall behind:

If patients were treated in Switzerland, instead of on the NHS, more than 4,300 lives would be saved each year

In Germany or Israel, more than 5,000 lives would be saved each year

•   Universal coverage is not unique to the NHS; almost every developed country has adopted a policy of universal access to healthcare, regardless of one’s ability to pay.

•   Even the rare studies, which give decent marks to the NHS, highlight its failures when it comes to patient outcomes. The Commonwealth Fund Study – which judged the UK to be the best healthcare system in 2014 and 2017 – also ranked the NHS tenth (out of eleven) in the health outcomes category.

•   The ‘pay as you go’ funding model is unsustainable given the UK’s ageing population. . The ratio of people of retirement age to people of working age currently stands at 28 to 100. This is forecast to rise to 47 to 100 by 2064. In the same period, the share of people aged 85 and over is forecast to rise from 4 for every 100 people of working age to 13 per 100.

•   Waiting times in the UK are much longer than those on the continent.

•   The NHS crudely rations: many innovative medicines that are available in other high-income countries are often hard to come by in the UK.

•   Technological innovations have not been adopted or invested in because there is little pressure to do so given the centralised funding system.

Policy recommendations for the NHS beyond 70:

• Quasi-market reforms of the 2000s should be built upon to improve patient choice, strengthen self-governance of providers and enshrine the principle that money follows the patient.


• Introducing pre-funding to the system through an old-age reserve for people of working age, would defuse the demographic time-bomb. As the number of elderly people grows, the reserves accumulated in the old-age funds would grow as well.

Commenting on the briefing, Kate Andrews, News Editor at the Institute of Economic Affairs, said:

“If policymakers are serious about improving patient care in this country, they should stop pouring money into a broken system, and instead look to the Social Health Insurance systems in Europe. These systems deliver better outcomes and prove that universal health coverage is not unique to the NHS.

“Hold the birthday cheers – the NHS is no longer fit for purpose. Genuine reform would be a truly meaningful gift – not to the bureaucratic structure of the NHS, but to the 65 million patients who depend on it.”

Notes to editors:

For media enquiries please contact Nerissa Chesterfield, Communications Officer: nchesterfield@iea.org.uk or 0207 799 8920 or 07791 390 268

To download the briefing, ‘How to structurally reform the NHS to improve patient outcomes’, please click here.

The mission of the Institute of Economic Affairs is to improve understanding of the fundamental institutions of a free society by analysing and expounding the role of markets in solving economic and social problems and seeks to provide analysis in order to improve the public understanding of economics.

The IEA is a registered educational charity and independent of all political parties.

Further IEA Reading: Universal healthcare without the NHS