The most interesting thing about Lord Ara Darzi’s report on the health service, expected to be published this Thursday, is how ministers decide to use it. The former health minister from the last Labour government was commissioned to carry out a rapid review of how well the NHS is functioning. He is expected to conclude that it really isn’t: yesterday, Keir Starmer said that Darzi was ‘really clear that the NHS is broken but not beaten’.
The Health Secretary is likely to call for higher capital funding in the next spending review
A lot of the pre-briefing so far has been that Darzi will say that the NHS is going backwards for the first time in 50 years on waiting times and deaths from heart disease. His report is also expected to state that the previous government left the service particularly poorly prepared for the pandemic. Ministers will certainly use that as part of their narrative that ‘the Tories broke everything’, but there is another finding that is more potent. The renowned surgeon is also expected to point out that the NHS is ‘undercapitalised’ and that Britain spends a considerably lower amount of money on buildings and equipment than other developed countries.
This is an indisputable point: the NHS lags behind other European countries on capital spend by around £3 billion, and is consistently below the OECD average for capital investment. What this means in equipment terms is that we have fewer CT and MRI scanners, and that NHS trusts have famously poor IT systems. The health service has an estates maintenance backlog of about £10 billion. ‘Estates maintenance’ sounds very boring until you realise that this covers the hospitals propped up with stilts or sections of the estate closed because they are not safe to operate in – meaning fewer operations taking place and fewer patients admitted.
Before the election, Wes Streeting liked to say that he was always trying to take Rachel Reeves around crumbling hospitals to make the case for higher investment in NHS infrastructure. He will be waving this report in the Chancellor’s face as part of that case, not least because there is currently a plan to take £800 million out of NHS capital spend and ‘redistribute’ it to day-to-day pressures arising from strike action and higher costs. That reallocation, incidentally, was one made under the Conservatives, so at least Labour has someone to blame for that – but the government still has to decide what its own priorities are over the next few years.
The Health Secretary is more likely to use the report to call for higher capital funding in the next spending review. Capital has long been something chancellors have felt they can afford to ignore: Darzi is trying to change that. The greatest reform coming from his report might not be to the NHS, but the Treasury.
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