Lord Darzi’s diagnosis shouts out that the NHS desperately needs more funding and that changing the existing model would do more harm than good.
Following nine weeks of reviewing data, Lord Darzi has now published his report ‘Independent Investigation of the National Health Service in England’, focusing on patient access, quality of care and the overall performance of the health system. Not surprisingly, his findings (summarised here) reflect those of health campaigners that have persistently highlighted the deteriorating state of the NHS for many years.
Worsening health inequalities that are socially determined are bringing more pressure on the NHS, while public health budgets have been slashed by 25%. A growing and less healthy population further increases demand. Darzi catalogues problems with delay in accessing care, missed targets and lost lives, and he identifies the main causes of poor productivity. First among these is austerity, ensuring that the NHS was in poor shape when the Covid pandemic hit. This determined massive disruption of routine care (e.g. 46% fewer hip replacements compared with an average fall in OECD countries of only 13%) from which impact we are struggling to recover.
Lack of capital investment (a £37bn shortfall compared with peer countries) has produced crumbling estate that is not conducive to productivity, with every day seeing services disrupted at multiple hospitals. One fifth of primary care estate predates the NHS. Lack of cash means that equipment is outdated, and processes have not been brought up to date. More investment is essential for the development of community services if the shift of care away from hospitals is to be realised.
Staff were worn out by the pandemic, and after effects are still present. However, Darzi pays generous tribute to health workers, recognising that they are profoundly passionate and motivated to give high quality care. He goes on to say:
‘Our staff in roles at every level are bound by a deep and abiding belief in NHS values and there is a shared passion and determination to make the NHS better for our patients. They are the beating heart of the NHS.’
Viewing the 2012 Health and Social Care Act as ‘a calamity without international precedent’ he warns that further top-down reorganisations are neither necessary nor desirable. Failings in the NHS cannot be laid at the door of managers, and any move to a different model of care would be unwise given that other health systems, such as those where user charges, social or private insurance play a bigger role, are more expensive.
According to Darzi, the NHS may be in a critical condition but its ‘vital signs’ are still strong. Given the right treatment, therefore, it could be restored to health. As set out in his terms of reference, Darzi has not ventured to suggest specific policy including addressing overall budgetary issues. However, it is clear he considers that austerity and ongoing underfunding have starved the NHS of the resources it needs to meet growing demand thus preventing it from functioning efficiently.
Darzi points out that with 2.8 million of the population economically inactive due to long term illness, having more people in work is crucial to growing the economy. Indeed, he states:
‘It is not a question of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around’.
When Wes Streeting, the Secretary of State for Health and Social Care, announced the Darzi review was being held, he is quoted as saying that it would aim at ‘diagnosing the problem’ so the Government could ‘write the prescription’. In the modern era, any treatment should be founded on the best available science while taking into account the views of patients and professionals.
Darzi’s conclusions after intense study of the data and a wide range of views are, on the face of it, surprisingly close to KONP’s assertion that the NHS, when funded to succeed, was and can be again one of the very best health systems:
‘Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use, and based on need, not ability to pay.’
For those such as Patricia Hewitt and Alan Milburn who question the very funding model on which the NHS has thrived, Darzi asserts:
‘Every advanced country has universal health coverage [except USA] but other health system models—those where user charges, social or private insurance play a bigger role—are more expensive.’
Darzi points to the evidence of a well-run health service after a decade of restorative funding in the 2000s, and when patient satisfaction was high with GPs and the NHS as a whole; and when targets for A&E and hospital treatment were well met by 2010.
Although the remit given to him prevented him from making funding recommendations, he is absolutely clear in his findings on the damage of underfunding since 2010:
‘The 2010s were the most austere decade since the NHS was founded, with spending growing at around 1 per cent in real terms…. The 2018 funding promise was broken…. Spending increased… below the historic rate [4% per year]…. The NHS has been starved of capital and the capital budget was repeatedly raided to plug holes in day-to-day spending.’
He blames this austerity – not staff – for much of the NHS ills:
‘Crumbling buildings, services disrupted at 13 hospitals a day in 2022-23, a backlog maintenance bill [of] more than £11.6 billion, and a lack of capital means [resulting in] too many outdated scanners, too little automation, and parts of the NHS yet to enter the digital era’
Importantly, Darzi deals with the myth that the NHS has too many managers, and this is worth emphasising:
‘Some have suggested that this is primarily a failure of NHS management. They are wrong…. Just imagine if all the effort and resource that had been poured into dissolving and reconstituting management structures [post the 2012 Act] had been invested in improving the delivery of services…. The result of the disruption was a permanent loss of capability from the NHS. Experienced managers left, meaning the NHS lost their skills, relationships and institutional memory…[Now] the number of managers per clinician has declined markedly over time. Despite what some media commentators may say, good management has a vital role in healthcare: it exists to ensure that the maximum healthcare value is created with the resources that are available. In providers, managers [should be] there to ensure efficient organisation and process so that clinicians can deliver high quality care to meet the needs of patients.’
How will Streeting, Starmer and Reeves use Darzi for their policy direction?
Streeting’s three ‘big shifts’ are:
- from hospital to community care
- from analogue to digital
- from treating sickness to preventing it
These are soundbites echoing through the last 25 years and nothing new. What is needed is a restoration of commitment to the NHS wholly publicly run and funded to succeed.
For Keep Our NHS Public, our three ‘big shift’s are:
- away from underfunding and to funding the NHS to succeed
- away from private outsourcing and to building back publicly provided NHS services
- away from fragmentation of services and to a reuniting of the national NHS
And we add a fourth important parallel ‘shift’:
- the establishment of a national service for care, support and independent living
Darzi has thrown down the gauntlet. Will the Government rise to the challenge or will it mistakenly conclude that the wrong treatments – ‘reform’ and further austerity – are just what the doctor ordered? If so, this would be a rebuff to Lord Darzi and – more importantly – a huge tragedy for patients, staff and the NHS.
While Darzi is unambiguous about underfunding and scathing on the 2012 Health and Social Care Act, he does not call for any change to the Health and Care Act 2022. He writes: “Some sanity has been restored by the 2022 Act which put integrated care systems
on a statutory basis. This has the makings of a sensible management structure,
consisting of a headquarters, seven regions and 42 integrated care boards (ICBs)
whose strategy to tackle inequalities, and to improve population health, is set by an
Integrated Care Partnership (ICP) that includes local government and the third
sector alongside the NHS itself.”
That is not KONP’s position – neither in the Vision for a People’s NHS nor in our comments on the HCA during and after it sailed through Parliament.
Well said. The ICBs are allowed to make a profit and actually have private healthcare reps sat on them?! The NHS should be publicly own and publicly provided as well as free at point of need.
I am a great supporter of NHS and welcome any changes that will improve and stabilize the service.
I am concerned that the NHS is being drawn down by the change in GP practices now being run by consortiums with the members of the consortia being made of fully qualified GP’s who no longer actually practice and yet take large profits.
This has reduced the number of GP’s and the practices are staffed now by student GP’s who understandably plan the same route.
The changes since 2019 the actual number of face to face appointments have reduced dramatically meaning that the onus has shifted to NHS hospitals. Indeed when you do manage to see a GP their fall back is to call 111 or 999 if it is out of surgery hours which are comparatively short.
This in my opinion is putting extra starin on hospitals and NHS and should be rectified as a matter of urgency.
Lord Darzi’s Report firmly states the NHS is failing due to long term funding constraints.
HMG has sadly totally failed its electorate’ needs which has led to crumbling buildings, and a management that simply could not cope with proper I.T. allowing a radical breakdown in staff being able to communicate between both different specialist departments and NHS Trusts. I.e. my wife ha two forms of cancer requiring at least 5 specialist management requirements. Totally stressed and unable to co-ordinate a proper team approach and follow-up procedures etc. Leading to delays caused by the inability to communicate with the various specialists. They should have a decent single system covering both Trusts and GPs etc.
One of our daughters is a Specialist Paediatrician and has been stressed out and whilst lorry drivers have to take breaks with a maximum time duration , staff like her are expected to make time to allow for hand-overs between shifts that regularly are extended far beyond a lorry drivers hours. Accidents are far more likely to occur – especially when a series of covering for other staff after 13 hours may mean that a lunch break at 4pm or later means that they’ve been working non-stop. They need more facilities and more colleagues to share the load,
We need to look at why staff have found it impossible to remain unheard by HMG.
Taxation needs to be raised considerably – and all income channels across the board must reflect a true and realistic levels of taxation for those earning obscenely high incomes that make the NHS staff and users simply unaware of their apparent poverty.
I agree that there is nothing wrong with the original model of the NHS – free,fair treatment to all at the point of service, and this should not be changed. I am losing faith in Keir Starmer’s government, and I hate to say it but Sunak was right in that we did not know what we were voting for. I strongly agree that the NHS should not be paying for private treatment, and believe that Labour needs to restore funding so that it can begin to function fully and address the needs of people waiting, prioritising those needing urgent care or treatment.
The NHS should be publicly own, publicly provided and free at point of use. The 2022 Health and Care Act, which created 42 Integrated Care Boards, allows each board to make profit (!!!) out of its allocated money! Private companies sit on these boards and can steer them in ways which improve their profits. This is a USA based model and results in care being reduced, rationed or denied in order to boost profits. If privatisation is not removed we’ve lost the nhs. It’s just a matter of time.
Of course the NHS should be publicly owned, publicly provided and free at the point of use. We need to get rid of the current piecemeal system (which costs much more in admin etc) and bring it back under one roof. Not only would it be simpler to run, but it would also be easier to find out what went wrong if there was a mistake and to take action to prevent it recurring.
Thé nhs mission is being watered down. It is not just a free service, which implies a charitable gift , it was always meant to be a universal and comprehensive service managed by the state and fully funded by taxation and national insurance.
That seems to be lost by Darzi. Instead there is reference to the NHS constitution and mandate which no one understands as anything more than political rhetoric, and a quasi legal basis for not providing a universal and comprehensive service.
Instead what has been created is a corporatist pie sharing arrangement geared to the rationing of healthcare for the masses, the maintenance of high demand for private treatment through shortages and waiting lists, and high profits for those in the supply chain.
Darzi provides an incomplete diagnosis and only suggests more of the same is in store.