NHS: The vital signs may have been strong (Darzi), but the prognosis remains uncertain

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In a piece originally published in Public Sector Focus, our Co-Chair, Dr John Puntis examines the government’s claims of progress on NHS reform, arguing that despite modest improvements, fundamental challenges remain largely unaddressed, leaving the service’s future uncertain.

In a recent speech (1), Secretary of State for Health and Social Care, Wes Streeting, covered the progress being made to reform the NHS. Despite an upbeat defence of Labour’s record over the past 20 months, he admitted that much more needs to be done. Priorities did include access to GPs and dentists, and shorter waiting lists, but largely missing was the crisis in A&E departments causing around 16,600 deaths each year (2). Only passing reference was made to lessons which might be learned from New Labour’s record of success in improving NHS performance: funding in-line with need, tackling the social determinants of ill-health and ensuring prevention through strong public health (3).

Manifesto promises

The party manifesto committed to getting back to 92% of patients being treated within 18 weeks, restoring the 4 hour A&E target and increasing numbers of appointments, investigations and staff. There was also endorsement of use of the private sector, portrayed as valued partners motivated by an altruistic desire to help. Recent findings from the Centre for Health and the Public Interest must prompt a re-think here. These show that private firms have made £1.6bn in profits from the NHS over the last two years. This amount of money could have prevented the current £1.1bn overspend by trusts that, according to UNISON, is now forcing thousands of redundancies in order to balance the books. Some manifesto promises were abandoned from the outset, for example progressing the New Hospital Programme and a major rolling back of outsourcing.

Progress or hype?

The findings of the recent Public Attitudes Survey have been used to claim public recognition of improvement in NHS performance. While offering a crumb of comfort, the numbers themselves were pretty dismal with only 26% being satisfied with the NHS (22% for A&E and dentistry) and a measly 14% with social care. Waiting lists may have fallen by 374,000 but this is only a 5% reduction and could be explained by removal of patients from the list via validation exercises rather than an increase in numbers treated.

A&E 4 hour targets have improved, but mainly for those with minor ailments while the most-sick increasingly lie on trolleys for extended periods. Improved ambulance response times provides little comfort for those with conditions requiring time sensitive intervention (e.g. heart attack, stroke) if then stuck waiting in A&E.

Claims around staffing increases also need putting in context. While additional mental health staff have indeed been delivered, numbers had been rising steadily for a decade while demand continues to soar. In addition, 14% of consultant posts are unfilled (up from 10% in 2021).

There may be 2,000 more GPs, but many of these are inexperienced and unable to match the volume of patients seen by a seasoned GP. As to ‘the highest number of GPs on record’, NHS statistics show there were 32,356 whole time equivalents in 2010 falling to 28,698 in 2025. Meanwhile, cuts to GP funding and rising workload means there is no sign of the return of the family doctor.

Sending ‘crack teams’ into hospital trusts with long waiting lists is said to have brought down numbers more quickly, but according to analysis by the Health Foundation this is due to fewer referrals being added to the list, while completed treatment pathways were actually higher in trusts without the teams.

Dentistry

Despite claiming 1.8 million more appointments, ‘dental deserts’ where many find it impossible to find an NHS dentist remain a huge problem. A recent investigation by Healthwatch found a 45% surge in dental-related A&E visits since 2019/20, people in deprived communities 67% more likely to need urgent treatment, and urgent care often limited to antibiotics or extractions, leaving patients in limbo with no follow-up or lasting relief. The much-needed reform of the dental contract seems nowhere in sight.

The end of corridor care in three years?

Mr. Streeting praised his local hospital in Romford for reducing corridor care, but in 2025 the NHS reported 554,018 trolley waits of more than 12 hours, while the true figure may have been almost twice this (4). Improvement at Queen’s in Romford was attributed to swift triaging decisions by a senior consultant. Trusts with the highest levels of corridor care will now receive bespoke plans and support to eradicate the practice by the end of 2029. In addition, there will be 40 new and expanded urgent treatment centres and same day emergency care services.

The Royal College of Emergency Medicine (whose members actually manage overwhelmed A&E departments) pointed out that ‘attendance avoidance services’ are not the answer to reducing corridor care. This is because they focus on the least unwell patients, while it is the most unwell or those with mental health problems who fill corridors. What in fact is required is a relentless focus on getting those who need admission out of A&E, including investment in additional beds, social care, community support and GP services (i.e. tackling service-wide structural issues).

This seems to be largely off the government radar, with attention focused primarily on elective care waiting lists. For now, despite a recent push, there is uncertainty around whether hitting a 65% target for treatment within 18 weeks (well below the previous 92% target set out in the NHS constitution) will be achieved in the near future. It is safe to assume that corridor care is unlikely to be reduced if mistakenly seen as a matter of local leadership rather than lack of national resources and direction.

Conclusion

Mr. Streeting’s characterisation of the NHS as ‘broken’ contradicted Lord Darzi – ‘in a critical condition but with strong vital signs’. He is now asking voters to believe that treatment is being implemented and the patient is on the road to recovery. To many, after 20 months of Labour in power, restoration of the NHS seems as badly needed as ever, and progress moving only at glacial pace. The 10 Year Plan for Health is brimming with techno-optimism but vague and un-costed. Labour still has time to do better while reflecting that failure will cause public disillusionment with politics and fuel the rise of the populist right. For the party ‘to be where it wants to be by the next election’, just to ‘gather speed and build more momentum’ may simply not be enough.

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