Lord Darzi had only nine weeks to conduct his investigation into and assessment of the National Health Service. But this truncated timeline does not appear to have led to any watering down of his verdict, published in a report today. The independent peer has delivered a damning diagnosis of the state of the NHS, which is described as being in a ‘critical condition’, failing both its staff and its patients.
It’s not exactly a secret that the NHS is on its knees. There have been countless reports and rankings of healthcare systems over the years that have highlighted just how poorly the NHS performs compares to its counterparts, especially when it comes to patient outcomes. The NHS has been missing every A&E target for almost a decade. Last year the King’s Fund revealed that the NHS came second-to-last in a list of 19 developed countries for saving lives when it came to ‘treatable’ illnesses.
The system’s poor track record on tackling common types of cancer has been well-documented for years, while an exploding NHS waiting list – which currently stands at 7.6 million – has brought to light just how hard it is to access healthcare in the UK, raising questions about whether an 18-week waiting list target is ever really acceptable to begin with.
But what is so shocking about Lord Darzi’s assessment is seeing all the evidence compiled together, with plenty of new information added to the long list of grievances. In short, a system that has record sums of money flowing into it is not leading to better results. The NHS hospital workforce has risen by 17 per cent between 2019 and 2023 – with ‘35 per cent more nurses working with adults and 75 per cent more with children than 15 years ago’ – yet productivity has not kept pace.
The horror of the waiting lists is even worse than had been assumed: ‘If you had arrived at a typical A&E on a typical evening in 2009,’ the report reads, ‘there would have been just under 40 people ahead of you in the queue. By 2024, that had swelled to more than 100 people.’
While the Prime Minister is unsurprisingly eager to use this report to point fingers at his opposition, the explanation for the current state of the NHS is far more nuanced. While it is certainly a painful critique of Tory leadership on the NHS, it is also clear that the slow deterioration of the health service was kicked into overdrive when the pandemic hit. ‘During the 2010s, NHS productivity increased more quickly than the wider public sector and in a number of years it rose faster than the economy as a whole. But there was a deep drop in NHS productivity during the pandemic when NHS productivity declined far more significantly than the economy as a whole or the wider public sector, as the chart below shows. It still remains below its 2019 level,’ the report reads.
The report also makes an interesting critique about the lack of capital investment in the NHS. According to Lord Darzi, there is a £37 billion shortfall, had we ‘matched peer countries’ levels of capital investment in the 2010s’. While this is no doubt a jibe at the ‘austerity’ policies pushed under David Cameron and George Osborne, it’s a point that applies well beyond those years. For decades governments have been making a trade-off. They have shunned long-term investment for short-term spending sugar rushes, and been more inclined to boost day-to-day spending than use the cash to invest in the future. It’s how you end up with an NHS, now, funded at a similar level to other developed countries, yet with hospital walls crumbling and ‘mental health patients being accommodated in Victorian-era cells infested with vermin.’
As horrifying as the details of Lord Darzi’s report are, there is some hope to be found in the fact that it was commissioned in the first place. ‘I asked Lord Darzi to tell hard truths about the state of the NHS’ Health Secretary Wes Streeting has said about the report he commissioned. ‘He has produced an honest, expert, comprehensive report on the appalling state our health service is in.’ It’s these kinds of ‘hard truths’ that have been avoided at all costs. This has cost lives: according to the report there have been ‘14,000 more deaths a year’ due to increased wait times, ‘more than double all British armed forces’ combat deaths since the health service was founded in 1948.’ Streeting, and Keir Starmer, decided years ago that part of Labour’s path back to power had to resist the common political urge in the UK to blindingly praise the NHS – so they might be able to do something about its ‘critical’ state once in power.
In this sense, the report is performing multiple functions for the new government. Having intentionally revealed the horrors of the health service, Labour now have no choice but to try to fix it. This is inevitably going to involve decisions that upset and disrupt at some point every stakeholder in the NHS.
The report also boosts Starmer’s argument that he’ll need a decade to change things (the unspoken part being that in five years’ time, at the next election, the NHS may still be in very poor health, and also experiencing the messy consequences of being mid-reform).
As encouraging as it is that Labour is willing to honestly address the failing of the NHS, the outstanding question remains exactly what kinds of reforms the party is willing to consider. Every healthcare system rations something: the question is what balance is struck to make sure everyone can fairly and quickly access the service. So far, Labour have ruled out any serious change to the fundamental structure of the NHS – including its funding model, fully covered by the taxpayer. This means the NHS will still be rationing with wait times, which will make faster access to care (and the expansion of preventative care) very difficult to deliver.
When you are dealing with a monolithic healthcare system, there is also always going to be the question of conflicting interests. Lord Darzi has called for a reform plan that is ‘going to have the fingerprints of NHS staff and patients all over it.’ But it is not hard to see how, quickly, these interests diverge. GPs have voted for collective action for the first time in 60 years, for example, with some calling for a cap on the number of patients they see per day. Meanwhile, many patients need GP hours extended so they can access care at night and at the weekends.
It’s a monumental task Labour are undertaking. Its chances of succeeding will be determined by how, exactly, they overhaul not just the UK’s largest institution, but one of the biggest institutions in the world. But for Starmer and Streeting, this isn’t optional. ‘Reform or die’, the Prime Minister is expected to say in his speech this morning about the future of the NHS. A serious attempt to get the NHS back on track may also determine the success, or otherwise, of Labour’s future electoral prospects. They will be judged on the outcomes, but the gamble they are taking is worth applauding: it’s been a long, long time since any party staked its own future on getting better outcomes for patients.
Hear Kate's analysis on today's Coffee House Shots podcast:
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