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A special “rapid investigation” of the National Health Service was commissioned by the health secretary, Wes Streeting, shortly after he came to office in July, and it has now reported. Headed by Ara Darzi, Baron Darzi of Denham, a highly distinguished surgeon and former Labour junior health minister, it highlights the problems faced by the NHS, and their causes.
The report will help form the basis of policy for the next few years as the government sets about fixing what Streeting calls a “broken” service. In the words of Keir Starmer, the report is “raw and honest”. It is also highly embarrassing for the Conservatives...
What does Lord Darzi say?
He is especially concerned about how failures across the system, such as in general practice and social care, have led to a “workload dump” onto the hospitals, and about the way in which the weaknesses in the NHS have led, in some cases, to poorer clinical outcomes. For example, he finds that “once adjusted for age, the cardiovascular disease mortality rate for people aged under 75 dropped significantly between 2001 and 2010. But improvements have stalled since then and the mortality rate started rising again during the Covid-19 pandemic.”
Who is Lord Darzi?
The Rt Hon Professor the Lord Darzi of Denham OM KBE FRS FMedSci HonFREng is a man of immense learning, skill and experience, and is widely respected. He has produced numerous other reports, including a previous review of the NHS for the then prime minister, Gordon Brown, in 2008.
Born in Baghdad of Armenian heritage, Darzi trained as a surgeon and has become a senior medical academic. He served as a minister under Brown and has been the recipient of multiple honours for his dedicated work. He is a longtime Labour supporter, but resigned the whip in 2019 over the antisemitism scandal.
What’s gone wrong?
There are three major factors: the Covid-19 pandemic; the major disruption during and after the 2012 NHS reorganisation under the then health secretary, Andrew Lansley; and, especially, the “decade of austerity from 2010”. Darzi concludes – as have many other experts, for example during the Covid inquiry – that the NHS was creaking even before the coronavirus outbreak.
He says it was underfunded by a cumulative £40bn or so during the 2010s, with infrastructure budgets being raised to pay for day-to-day services – which is how the frontline NHS services were “ring-fenced” from cuts during the Conservative-Liberal Democrat coalition, but obviously, the cuts to investment were going to have deleterious long-term consequences.
In addition, the Johnson administration’s hospital-building programme, with its promise of 40 new hospitals, wasn’t fully completed. So, to put it bluntly, it’s the Tories’ fault.
What about Brexit?
Not mentioned, to the surprise of some, given its baleful impact on economic growth, tax receipts, and, most pertinently, the supply of skilled and semi-skilled workers from the rest of Europe, NHS vacancies now being at an all-time high.
How will it be put right?
With difficulty, given the state of the economy and the tremendous demands on the NHS, exacerbated by demographic trends. Darzi warns that lifestyle trends and cuts in public health budgets are also causing problems – “There has been a surge in multiple long-term conditions, and, particularly among children and young people, in mental health needs. Fewer children are getting the immunisations they need to protect their health and fewer adults are participating in some of the key screening programmes, such as for breast cancer.”
For his part, Streeting stresses the need for reform as well as funding, and has identified three “strategic shifts” for the NHS: moving care from “hospital to community”; abandoning paper to go from “analogue to digital”; and a change in the focus from “treatment to prevention”.
Will it work?
The sheer scale of the task is daunting, but in Streeting, the health department has a highly intelligent, articulate and effective operator with a “failure is not an option” attitude. He is focused on both reform and delivery, but he will need the backing of the prime minister and the chancellor if the Labour government is to avoid falling into the same traps as its predecessor did.
The danger is that the promises made to fix the NHS don’t yield sufficient palpable progress in care, or in patient satisfaction, to convince the public that the NHS is the best way to secure quality healthcare. The fortunes of the Labour Party, not to mention those of Streeting, are tightly attached to the recovery of the NHS. It was, in large part, what Starmer and his colleagues were elected to do, and what the tax hikes should really be all about.
