“This report has not held back,” Lord Darzi writes in the opening section of the Independent Investigation of the National Health Service in England, a promise that the report certainly lives up to.
The Darzi report, which identifies problems with the NHS and has been welcomed by the Labour government, with the Prime Minister calling it a “raw and honest assessment” of the health service. With the report directing the blame primarily towards decisions under the previous conservative government, the Brown and Blair ministries come out of the report unscathed.
It has been criticised by Shadow Health Secretary Victoria Atkins, who described the report as “cover for the Labour party to raise our taxes in the budget” before its public release.
What is the Darzi Report?
The independent investigation was commissioned by the new Health Secretary Wes Streeting immediately following the General Election on July 4.
Ara Darzi worked as a practicing surgeon, specialising in robot-assisted surgery and has been a professor at Imperial College since 1996. Lord Darzi has previously led a number of reports on the NHS commissioned by both Labour and Conservative governments. He has also contributed to Curia’s Health, Care, and Life Sciences Research Group, namely on the 2024 Implementation Plan of a Life Sciences Industrial Strategy for a New Government report.
Whilst concerns have been raised about the short notice of the report, something the report itself acknowledges, Lord Darzi is having a detailed understanding of the organisation of the NHS.
What’s wrong with the NHS?
The report looked at all NHS activity, from mental health to cancer treatments. As such, it’s hard to summarise every problem identified, but the various problems facing the NHS stem from several causes.
- Austerity
“Austerity in funding and capital starvation” is the largest problem identified. It has led to reduced efficiency and quality of care and has in fact actually cost more in the long term. However, austerity in NHS funding isn’t the largest problem identified by the report. “Social determinants of health,” such as “poor quality housing” has damaged public health and increased the NHS’ load.
- Covid 19
Underfunding meant that the NHS was ill-equipped to prepare for the shock of the pandemic. The pandemic has resulted in a large backlog, putting stress on various elements of the system.
- Staff productivity and morale
Due to the problems previously mentioned, productivity has fallen significantly. This has had stretching impacts on the NHS. Falling productivity, the report argues, “doesn’t reduce the workload for staff, rather, it crushes their enjoyment of work.” The result has been a series of “retention crises.” Whilst the number of staff has increased, the exodus of skilled staff has caused productivity to fall further.
How do we fix these problems?
Despite the generally negative tone of the report, it concludes that the NHS’ “vital signs are strong”. It points to the “deep and abiding belief in NHS values” among staff which has enabled them to work in poor conditions.
The main problem it identifies to be solved is productivity.
Most simply, it calls for “capital investment” in areas left in disrepair over the last decade.
However, it also proposes more systemic changes. One of the ways it seeks to do this is by reforming management. The “disastrous” NHS management reforms of 2012 resulted in reduced productivity by shifting bureaucracy on to other staff. Reforms would “invest in the quality and capacity of management.”
Another solution laid out to improve worker productivity is the use of AI in healthcare. The suggestions come in the aftermath of a report by the Tony Blair institute which found that the rollout of AI in the sector could save the NHS £200 Billion over Labour’s five years in office.
These reforms would, of course, cost money. Although bringing long-term reductions in cost, they will involve significant initial investment.
Whilst the government have generally been incredibly supportive of the report’s findings, there are likely to be concerns about the price tag. In an interview with the BBC this morning, Wes Streeting stated that reforms may have to be done “over a longer period of time” due to immediate fiscal concerns.
However, at the same time, the Health Minister signalled that the government understood that leaving problems to solve later would likely only increase costs. He warned that if costs were allowed to pile up, the UK could become an “NHS with a country attached to it.”
Whilst the government acknowledges that delaying change will only problems worse and worsen government finances, it is limited in what it can do with such dire fiscal circumstances.
Final Thought
As the report acknowledges “Everyone knows that the health service is in trouble.” In this sense, the Darzi report doesn’t tell us anything new. However, the report does give a glimmer of hope in showing the specific problems with the NHS and how they can be fixed.
It also identifies the positives that NHS reform would bring. As well as curtailing ballooning costs, the report echoes government sentiment in stating that reducing NHS waiting lists will have a positive impact on the economy by allowing more people to enter the work force.
However, this aim may be at odds with the “black hole” the government has reported to exist in the country’s finances. It should be remembered that cutting funding from other public services was identified in the report as being a critical issue. Depending on what is cut to offset higher NHS spending, the government might increase the load for the NHS.
Balancing between long-term decisions and immediate fiscal problems will be one of the several “difficult decisions” that the Chancellor will have to make in the run-up to the budget next month.
Health, Care, and Life Sciences Research Group
Curia’s Health, Care, and Life Sciences Research Group were pleased to work with Lord Ara Darzi earlier this year, on our Implementation Plan of the Life Sciences Industrial Strategy for a new Government report. As Curia begins work supporting the implementation of Government policy, particularly with frontbench parliamentarians in the Department for Science, Innovation and Technology and the Department of Health and Social Care, join us now as a Subscriber, to not miss out.
Contact team@curiauk.com to find out more