The IPPR said returning productivity to pre-pandemic levels would have freed up over £19bn in 2023/24, while increasing productivity by 2% could unlock £3.8bn a year. In 2023/24, the NHS in England had a budget of £171bn, but productivity was 11% lower than before the pandemic according to NHS England estimates.

If productivity had matched 2019/20 levels, the NHS could have delivered an extra £19bn worth of care, the IPPR states. This would have been enough to build 900 new health centres — almost enough to deliver the Labour Party manifesto promise to build ‘Neighbourhood NHS' in one year alone. In addition, meeting the NHS 2029/30 2% productivity target would deliver an additional £3.8bn worth of care by tripling the numbers of MRI and CT scanners.

Dr Annie Williamson, IPPR research fellow and a current NHS doctor, said: ‘After years of mounting pressures, the NHS is facing two major challenges: high levels of frustration among staff and low productivity which is taking a toll on patients.

‘By addressing these issues, we could unlock billions worth of better healthcare. More importantly, this would create a more efficient and sustainable health service, where staff voice is central to improving the quality of decisions throughout the NHS.'

The report argues giving workers a greater say, including new NHS staff boards, was key to boosting productivity and increasing retention. 

It reveals 150,000 additional staff could have been retained between 2010 and 2023 if the leaver rate had been kept at the rate of 9.5% in 2009/10 instead of rising to 11.2%.

The IPPR argues low productivity and poor staff retention reinforce each other as high staff turnover increases costs and impacts care delivery, while inefficiencies, such as outdated equipment, deepen staff dissatisfaction and lower productivity levels. 

Low autonomy for NHS workers is a key underlying issue, the report finds, with decision making often lacking information and insights from frontline staff, leading to the wrong priorities and missed improvements.

The think-tank calls for reforms to incorporate staff voices in clinical service design and national policymaking including:

• empowering frontline staff by establishing channels for service improvement led by trust-level specialists, with protected time for all staff to participate

• setting up representative staff boards in each NHS trust to put forward ideas from the wider workforce and consult on all matters affecting staff wellbeing, with a duty on main NHS trust boards to consult them

• giving staff a voice in national workforce policy by reforming pay review bodies to include negotiation or embed a formal duty to consult with staff.

‘Dr Parth Patel, associate director of democracy and politics, said: ‘We all know the NHS needs reform, but we keep getting distracted by the same red herring debates. The real issue is that we're struggling to get the NHS firing on all cylinders again.

‘Too many decisions are made at the top, while those on the front lines—who truly understand what's needed—are left with little say. The status quo isn't working. We need to empower NHS staff with a genuine voice and a real stake in the decisions that affect them. Only then can we unlock the NHS' full potential again.'