In July 2024, the Secretary of State for Health and Social Care commissioned Lord Darzi to conduct an immediate and independent investigation of the NHS.[1]
The aim of Lord Darzi’s report was to provide an expert understanding of the current performance of the NHS across England and the challenges facing the healthcare system. With the available data and intelligence, Lord Darzi set out to assess:[2]
- patient access to healthcare
- the quality of healthcare being provided
- the overall performance of the health system
Lord Darzi states that the terms of reference for the report preclude him from making policy recommendations. Hence, without providing policy detail, the report sets out the major themes which Lord Darzi believes should provide the foundation for the forthcoming 10-year health plan.
What is the current state of the NHS?
Lord Darzi’s investigation found that the NHS is in a ‘critical condition’ among growing waiting lists and the deterioration of the nation’s health.[3] The report outlines four inter-related factors that have contributed to the current conditions:[4]
- Austerity in funding and capital starvation;
- The impact of the Covid-19 pandemic and its aftermath;
- Lack of patient voice and staff engagement; and,
- Management structures and systems.
Lord Darzi’s report reflects several themes that align closely with the prevailing health and care discourse, as well as the objectives outlined in the 2019 Long Term Plan.
Digital transformation
Lord Darzi places considerable emphasis on embodying a ‘tilt towards technology’ to unlock productivity and transform the NHS. He points to AI, data integration and utilising new technology instruments for life sciences breakthroughs to create new treatments.
Improving the workforce
Lord Darzi underlines the importance of re-engaging staff and re-empowering patients, particularly following the Covid-19 pandemic. However, he maintains that despite all recent challenges and low morale, NHS staff are profoundly passionate and motivated to raise the quality of care for patients.
Out-of-hospital care
The report highlights the need to simplify and innovate care delivery for a neighbourhood NHS. Lord Darzi maintains the need to embrace new multidisciplinary models of care that bring together primary, community and mental health services.
What’s new?
Lord Darzi’s report also sets out some more radical reforms that he recommends can shape the new 10 year plan for health and care.
Reform to make the structure deliver
Lord Darzi maintains that more work is needed to clarify roles and accountabilities for NHS England and Integrated Care Boards. This is necessary to ensure the right balance of management resources in different parts of the structure, and strengthen key processes such as capital approvals.
Contribute to the nation’s prosperity
The report highlights the crucial link between the nation’s health and economic prosperity.
Lord Darzi maintains that with the NHS budget at £165 billion this year, the health service’s productivity is vital for national prosperity. Moreover, the NHS must rebuild its capacity to get more people off waiting lists and back into work. He also calls for the NHS to better support British biopharmaceutical companies.
Funding reforms
Lord Darzi states that the NHS must lock in the shift of care closer to home by hardwiring financial flows. In line with an aging population, GPs, mental health and community services will need to expand and adapt to the needs of those with long-term conditions. Lord Darzi maintains that financial flows must lock-in this change irreversibly or it will not happen.
Next Steps: Saving the NHS
Whilst Lord Darzi’s report details an NHS in ‘critical condition’,[5] struggling with the aftermath of the pandemic, diminished managerial capacity, and lost trust among frontline staff he makes clear that the NHS’s vital signs remain strong. He credits exceptions – clinical talent and a commitment to core values among staff. He also claims that the principles of a tax-payer funded, universal health service are vital.
The report suggests that although it will take time to restore the NHS to peak performance there is potential for significant progress, particularly in reducing waiting times. Nonetheless, achieving comprehensive recovery will require more than one parliamentary term.
[1] DHSC, ‘Independent Investigation of the National Health Service in England Report’, 12 September 2024, link
[2] Ibid
[3] Ibid
[4] Ibid
[5] Ibid
