How we fix our “broken” NHS: Darzi review analysis
Today the government published the full findings of the independent review into the state of the NHS, led by surgeon and former Labour health minister Lord Darzi. The report reveals a range of deeply concerning trends in the decline of patient care - none of which will come as a surprise to the people who use or work in the NHS. Speaking about the findings, Prime Minister Keir Starmer has said it shows the NHS is “broken but not beaten.”
Here’s Just Treatment’s headline take on the Darzi review report:
Every day we hear stories from our supporters that tell the human story of the collapse in NHS care described in Lord Darzi’s review.
Whilst COVID played a role in its decline, it is clear that ideologically driven decisions by successive government ministers to starve the NHS of funding and push through damaging pro-privatisation reforms are responsible for the status quo, where 14,000 people are dying avoidable deaths every year because of the mess these politicians have made of the NHS.
The key question now is: what “solutions” will the government advocate for in response? The noises from Labour so far are deeply concerning.
Fixing a health service that has lost out on £362 billion pounds of real terms funding through austerity without committing to a dramatic increase in resources is simply not credible. Launching big reforms without resources to enact them is neither realistic nor responsible. Furthermore, investing in further private sector provision of care, or pinning hopes on big tech or big pharma techno fixes risks doubling down on the mistakes that helped to cause this crisis.
This report paints a serious picture of NHS decline - the government must come up with more serious solutions.
Read on for more on what you need to know about the Darzi review, and what action the government must take to tackle these major challenges:
First up, the key findings.
The report says that 14,000 people are dying unnecessary and avoidable deaths due to the chaos in our A&E departments. The report also concludes that heart disease progress has regressed, as care standards have slipped due to longer wait times in hospitals. As a result, the heart disease mortality rate for people aged under 75 has begun rising again in the past few years. Cancer care is not keeping pace with comparable nations.
The report also has a big focus on children’s and young people’s health, and the trends it exposes are alarming. More than 100,000 infants up to the age of two were left waiting for more than six hours in A&E departments in England last year. Life-threatening and life-limiting conditions among children are up 40% in the past 20 years.
In the area of mental health, demand is rapidly rising. For example, hospital admissions for children and young people with eating disorders are up by 82% since 2019-20. Our underfunded mental health services are severely under equipped to deal with this crisis.
Everyone is aware of the huge waiting lists for treatment and care, again something Darzi highlighted as being created under the last government’s watch. Far more NHS appointments were cancelled during COVID than other nations.
NHS buildings are crumbling, scanners and other technical medical equipment are often archaid, and digital tech is 15 years out of date.
Why has this happened?
The review points to several core drivers for these worrying trends. Darzi reaffirms that the NHS is still struggling with the aftermath of the COVID crisis, which it was seriously under equipped to deal with due to being weakened by the health policies imposed by previous Conservative governments.
In particular, Darzi points to the top-down reorganisation of the NHS spearheaded by former Tory health secretary Andrew Lansley, which he describes as “disastrous” and resulted in “a permanent loss of capability from the NHS”.
The report also criticises the major funding cuts to the NHS budget imposed by the coalition government of Conservatives and Liberal Democrats in the early 2010s, which were part of the wider devastating austerity agenda.
He also argues that staff and patient voices have not been heard loudly enough by NHS decision makers.
So, now what?
There is no doubt that disastrous health policies implemented by the Conservatives over the past decade and a half have created a crisis in the NHS that is having devastating consequences for patients. Now, Labour are in charge, and they have the opportunity to correct these grave mistakes and forge a different path forward. Yet so far, their plans fall far short of the real solutions that are needed.
There is no escaping the fact that significant increases in NHS investment are essential to tackling these issues. The decade of austerity saw the NHS budget flatlining, meaning it lost out on £362bn in funding it should have received if funds had kept pace with historic average increases in investment. Meanwhile, demand has only increased, meaning our exhausted health workers have been expected to do far more with fewer resources. This is not sustainable.
Yet Labour have so far refused to commit to increased funding, beyond a measly £1.1bn that will supposedly fund 40,000 extra appointments a week. These plans have been widely criticised as insufficient, including by the NHS confederation whose analysis found that the plans will not be enough on its own to achieve the government’s 18-week waiting time target by the end of this parliament.
Both the NHS Confederation and Lord Darzi himself have urged Labour to commit to investment in capital infrastructure, in the face of crumbling facilities that are playing a major role in delays to care and a reduction in quality of treatment. Since 2010 the NHS has spent between £3bn and £4bn a year less on infrastructure than other western European countries, with a cumulative gap of £33bn in the years before the pandemic.
On mental health services, we know that the level of resource and capacity is deeply inadequate. Millions are stuck on waiting lists for mental health support, including over 270,300 children and young people. There are also over 28,600 vacancies in mental health services across the UK. Investment and reform is critical.
But we must also look at what’s driving the increase in poor mental health in the first place, especially amongst young people. For example, we know that there is a wide range of research that links the practices of social media companies to an increase in image-based mental health disorders. These companies are making billions in profit whilst fuelling ill health. The government should be holding them to account, challenging their practices and increasing taxes on them in order to fund urgently needed treatment.
Beyond funding, Labour have also pledged to increase reliance on the private sector; a sector which has already hoovered up hundreds of millions of taxpayers’ money through outsourced contracts. They claim the private sector will help to tackle the backlog, but this approach is deeply flawed and dangerous. The private sector relies on NHS-trained staff, which means it actively drains capacity away from the public health service. Private providers also cherry pick the least complicated patient cases, leaving our struggling NHS to deal with disproportionately complex ones.
Finally, the review repeatedly argues that new medicines, tech, and AI will solve all manner of issues facing the NHS. Even going so far as to say that the NHS should “better support British biopharmaceutical companies”. But this uncritical view of these technologies, and the industries that profit from them, holds huge risks for the NHS. We are concerned, like many others, that an over-reliance on these profit-driven sectors will worsen patient care, waste taxpayer funds, entrench health inequalities, crowd out proven public health interventions, justify budget cuts and low quality care, weaken the public service ethos of the NHS, and deliver windfall monopoly profits for corporations. Failing to acknowledge and plan to manage these risks is dangerous and unacceptable.
Labour are justified in pointing out the failed NHS policies of their predecessors. But it would be unforgivable to make the same mistakes - and right now that’s the path they seem to be choosing.
Patients and the NHS need increased investment, not a new iteration of austerity. We want well-equipped and well-staffed public health services, not hundreds of millions going straight into the pockets of private healthcare corporations. It’s time the government faced facts and took the bold action needed to tackle the NHS crisis.