Summary

One of Wes Streeting’s first acts as incoming Secretary of State for Health and Social Care was to commission Professor the Lord Ara Darzi to conduct an immediate and independent investigation of the NHS in England.

Lord Darzi, who has been a surgeon for over thirty years, was tasked with assessing patient access, quality of care and the overall performance of the health system. Those working within the health sector were invited to contribute evidence for the review.

His findings painted a picture of a health system that’s underfunded and overstretched, weakened by austerity and the pandemic’s aftermath. With many political undertones, the report describes an NHS which ‘has been chronically weakened by a lack of capital investment’, whilst
demands have increased and the nation’s health deteriorated, leading to patients and citizens across the country losing faith in the service.
The report outlines the full state of the NHS, how it reached this point, and key themes for recovery.

Although many of his findings are well-known challenges facing the NHS, they point to a challenging situation and diagnosis of the problems within the health service. These included:

• Over the past 15 years, there has been a significant rise in people living with multiple long term conditions, worsening the overall health of the nation.
• A disproportionate share of the NHS budget is allocated to hospitals, with insufficient investment in community care. This shift of funding towards hospitals has increased over time.
• Hospital productivity has fallen, drawing excessive resources away from community based care.
• Waiting lists and A&E delays have worsened, with queues doubling since 2009. Currently, 1 in 10 patients wait 12 hours or more for emergency care.
• The UK has higher cancer mortality rates than other countries, with no improvement in early-stage cancer diagnosis between 2013 and 2021.
• The Lansley reforms of the 2012 Health and Social Care Act caused lasting harm to NHS management, taking a decade to recover, with ongoing effects still being felt today.
• Patients are not engaged enough, and the patient voice is not loud enough ensure they are empowered to make informed choices about their care.
• The NHS is not contributing to national prosperity, with reduced access to care impacting people’s ability to work and live fulfilling lives.

The nation’s declining health, influenced by poor social conditions such as housing, low income, and insecure employment, has contributed to the NHS’s strain. Life expectancy stalled in the 2010s, worsened by the pandemic, and the public health system has seen cuts in real terms, with fewer people participating in essential health services like immunisations and screenings.

In his conclusions, Lord Darzi outlines a broad roadmap to improve the NHS over the next ten years, with themes that will shape the forthcoming 10-year health plan, which will commence over the coming months.

This roadmap is framed around:

• Re-engaging staff and empowering patients.
• Lock in the shift to more community-based care, closer to home, by hardwiring financial flows to the primary care sector and community services, with a simplified and innovative care delivery plan for a neighbourhood NHS.
• Improve productivity in hospitals by fixing flow through better operational management, capital investment and modern buildings and equipment.
• ‘Tilt towards technology’ and ensure that hospitals benefit from modern digital and IT systems, and utilise AI to support the wider life sciences sector.
• Have the NHS contribute to the nation’s prosperity by getting people off waiting lists and supporting life sciences industry to drive innovation and economic growth.
• Utilise ICBs and current structures to reform the system by clarifying roles and responsibilities, empowering NHS bodies and improving capital approvals.

The chapter on technology provides a useful analysis of the challenges faced by the NHS and innovators in driving adoption of technology in the system. Darzi notes that although there are instances of where technology has supported the NHS, “it has not radically reshaped services”, and that the NHS has not realised the benefits of IT. It points to significant national investment in initiatives (such as the Federated Data Platform), but points to the failure of the NHS App to live up to its potential. These failures are felt across many areas, with the NHS not fully realising the benefits of a range of technologies and innovations, which could improve services, support patient care closer to home, and drive economic growth.

Lord Darzi stops short of calling for another top-down restructure of the NHS, and supports the retention of the ICS model which has been in place for several year; but the challenges outlined in his report will require significant contributions of political will, system and patient support, and financial stimulus. Without these, reform will be impossible.

The report itself provides Wes Streeting with an independent diagnosis of the challenges facing the NHS, and will act as a framework for his 10-Year Plan for the NHS, which will supersede Jeremy Hunt’s 10 Year Vision for the NHS. The scale of the challenge is great, and there is a
recognition that the NHS cannot be “fixed” in the short-term; but that it will take years to manage. It is the development of the 10-Year Plan which will provide the structure of the reforms which are necessary to deliver change and better patient outcomes. Further details will no doubt be provided in the budget (taking place on 30th October), where future investment in the NHS will be outlined.

Prime Minister’s remarks

The Prime Minister described the findings as “unforgiveable” and called for a “reimagining” of the NHS. In a speech he delivered shortly after the report was published, Starmer outlined three major reforms needed to revitalise the health service, with a focus on a 10-year plan to address critical issues.

Firstly, he proposes moving the NHS from an analogue to a digital system, using technology to give patients more control over their healthcare. Second, he advocated for a shift from hospitalcentric care to community services, including improving GP access and digital consultations to tackle health issues earlier. Lastly, Starmer recommended a shift from treating sickness to prevention, aiming for long-term investments in technologies that prevent health issues, such as in children’s mental health and dentistry.

Starmer criticised the previous Conservative government for what he called a “lost decade” of underinvestment, which left the NHS in a fragile state even before the pandemic. He described the current state of A&E waiting times as “devastating, heart-breaking, and infuriating,” leading to avoidable deaths.

He emphasised that reform is necessary for the NHS to survive, stating, the NHS must “reform or die,” while maintaining that the NHS should remain free at the point of use. Starmer concluded by acknowledging public anger about the NHS’s condition, stating that people have a right to be upset with the system’s failures, which in some cases are “life or death.”

Remarks from Notable Stakeholders

Following the launch of the report, many parts of the system, and external stakeholders commented on the scale of the challenge, and the next steps.

Amanda Pritchard, Chief Executive of NHS England, acknowledged the critical challenges faced by NHS staff, who she described as “the beating heart of the NHS”, and admitted that current waiting times are “unacceptable”.

Sarah Woolnough, Chief Executive of The King’s Fund, similarly commented that “incremental improvement will not do” and that “radical change is needed,” emphasising that “the task is not simply to prop the NHS back up; it is to create a new approach to health and care in this country.”

Thea Stein, Chief Executive of the Nuffield Trust, responded by noting that the problems have been growing “in plain sight for years” and that the findings, while not surprising, are “deeply troubling.”

Peter Ellingworth, Chief Executive of the Association of British HealthTech Industries (ABHI), asserted that “HealthTech has a vital role to play in driving innovation, improving productivity, and ultimately supporting the NHS in delivering better outcomes for patients.” He pointed to NHS England’s Innovation Ecosystem Programme as a key part of future solutions and expressed ABHI’s commitment to partnering with NHS leadership to ensure technology plays a central role in reforms.

Tony Blair Institute’s Director of Health Policy, Dr Charlotte Refsum, also responded to the report findings by advocating for the establishment of a “National Data Trust” to support research and development, and a “Digital Health Record” to enhance direct patient care. She asserts that these initiatives could “drive efficiency, innovation and transform the care we can provide.”

The PLMR Healthcomms team will continue to monitor the latest developments in the 10-Year Plan, and will provide further details in due course.

Contact Information

For more information, please contact Jack Nagy via jack@healthcommsconsulting.co.uk