NHS ranked second-worst in rich nations for preventable deaths
The UK’s National Health Service is under unprecedented strain, and new data paints a sobering picture.
On treatable mortality, deaths from conditions that timely care should prevent, the NHS records 71 deaths per 100,000 people, the second-worst performance among 22 wealthy OECD nations analysed. Only the United States fares worse.
The finding comes from a major new report by the Institute for Public Policy Research (IPPR), which directly addresses a growing political debate: whether the NHS’s tax-funded, free-at-the-point-of-use model is fundamentally broken and should be replaced by a social health insurance (SHI) system like those in continental Europe.
The report shows it’s not the model but the money and the management involved which needs fixing.
No clear winner between Bismarck and Beveridge
The IPPR analyzed 22 high-income OECD countries, splitting them into tax-funded “Beveridge” systems (like the UK, Sweden, Canada, and Australia) and payroll-funded “Bismarck” social health insurance systems (France, Germany, Netherlands, etc.). The US was kept in a separate “other” category.
Key takeaway was that performance varies far more within funding models than between them.
- Tax-funded systems show clear advantages in equity and administrative efficiency. Out-of-pocket spending is lower (3.2% of household consumption vs 3.5% in SHI), and administrative costs eat up just 2.2% of total health spending compared with 3.5% in SHI systems.
- SHI systems tend to have more physical capacity – more hospital beds (6.7 vs 2.7 per 1,000 people) and more diagnostic equipment – and slightly higher satisfaction with access.
- But on quality metrics like treatable mortality and heart-attack outcomes, the two models are broadly similar.
Why the NHS is struggling
The NHS’s poor ranking on preventable deaths is real, but the report pins the blame squarely on practical failures, not the Beveridge model:
- Chronic underinvestment in capital: NHS capital formation is just 0.4% of GDP, roughly half the basket average and less than half that of top-performing tax-funded peers like Australia, Norway, and Denmark.
- Fewer beds and scanners: The UK has only 2.4 hospital beds per 1,000 people and 19 diagnostic machines per million, well below both model averages.
- Unsustainable pressure: Years of running the system “too hard for too long” without adequate resources have led to record waiting lists and exhausted staff.
Public dissatisfaction is high, 51% of British adults were unhappy with the NHS in 2025, but 89% still want it free at the point of use, and 81% want it tax-funded.
What would actually move the needle?
The IPPR sets out four targeted priorities that would deliver the biggest bang for the buck:
- Sustained capital investment to fix the infrastructure deficit (the government should revisit the 2025 spending review settlement).
- A genuine shift to primary and community care – neighbourhood-based services that manage long-term conditions more effectively and at lower cost.
- Serious resourcing of long-term and social care – the Netherlands spends roughly three times more per capita than the UK.
- A more ambitious public health and prevention strategy – far more cost-effective than pouring money into acute NHS services.
Even with those fixes, the report warns that tough conversations lie ahead as medical costs and capabilities continue to expand. “That conversation can no longer be deferred,” it concludes.
