Darzi has delivered a diagnosis for the NHS – now we need to know the treatment will be evidence based says Dr John Puntis
Lord Darzi is an academic surgeon and Professor at Imperial College London, working in both the public and the private sector, and a former Labour Under-Secretary of State for Health. Sitting as a Labour peer in the House of Lords, he resigned the whip over allegations of antisemitism in the party. His recently delivered report on the state of the NHS was produced after nine weeks reviewing and summarising published data.
Commissioned by Wes Streeting, Secretary of State for Health and Social Care, Darzi was asked to focus on patient access, quality of care and overall performance of the health system. He was not asked to propose any solutions or to examine the state of the failing social care sector. His report lays bare the shocking state of the NHS after 14 years of austerity. Darzi concluded that its condition was critical, but vital signs remained strong. In other words, given the right care and attention, the NHS could be restored to good health.
The NHS is failing patients
Difficulty in accessing services and low overall spending were major contributors to the NHS losing its pre-eminent position among rich countries in the 2021 rankings by the prestigious Commonwealth Fund. Before the Darzi report, much ink had flowed in describing the failings in health care. Darzi claims to have been shocked by his findings, but many would be well known to health workers, patients, commentators and think tanks. They include growing waiting lists, deteriorating health and life expectancy, increased maternal mortality, worsening health inequalities, disappearing pharmacies and GP surgeries, dentists who won’t see NHS patients, and Emergency Department delays leading to an estimated 14,000 avoidable deaths each year.
We now wait to see how the report will be used to shape the coming ten-year plan. In the meantime, it has bought Labour some time while laying the blame for failure squarely with Conservative governments. Streeting previously explained that Darzi’s purpose was to carry out a thorough examination before coming to a diagnosis, while it would then be up to government to prescribe the right treatment.
In the current age of evidence-based medicine, treatment must be based on the scientific evidence for what is known to work and informed by the insights of those staffing the service together with the wishes of the patient (or in this case, the public). It would be wise also to heed some of Darzi’s insights: ‘other health system models – those where user charges, social or private insurance play a bigger role – are more expensive’; ‘the health service’s productivity is vital for national prosperity’; ‘it is not a question of whether we can afford the NHS – rather, we cannot afford not to have the NHS’.
Wrong direction of travel
Labour clearly wants to prioritise unspecified ‘reform’ over investment despite the fact that without significant funding it is unlikely that the increasing gap between NHS capacity and growing demand can be closed. Darzi emphasised the huge damage done by austerity, and the lack of capital investment (£37bn compared with peer countries) holding back NHS productivity, together with an £11.6bn backlog in maintenance funding needed to restore rundown buildings and equipment.
The manifesto commitment to the New Hospital Programme was quickly modified in favour of delay and pending review of projects on financial grounds. Rather than the increased funding for staff and facilities under the last Labour government being seen as an object lesson in how to bring down waiting lists and improve public satisfaction, it seems we now need only ‘three shifts’ – from hospital to community, a focus on prevention, and employment of new technology. Important though these are, they are hardly novel (featuring for example in the 2014 NHS ‘Five Year Forward View’) and unlikely to succeed unless underwritten by cash.
Ideological blinkers
While decrying the 2012 Health and Social Care Act as ‘a calamity without international precedent’, Darzi regards the 2022 Health and Care Act which fragmented the NHS into 42 Integrated Care Systems as a positive. He is untroubled by Labour’s past use of outsourcing and ‘patient choice’ to promote a two-tier service. Streeting believes that rather than being the recipient of investment to boost productivity, the NHS should send patients to the private sector, despite evidence that this entails greater expense, reduces quality of care, undermines NHS teams and services, and provides little extra capacity.
Although overall funding of the NHS has risen, taking into account population growth, demographic changes and increase in chronic sickness, per capita spending in relation to health needs has actually decreased. In addition, comparable European countries with better outcomes are simply spending a lot more on health than the UK. Furthermore, the founding model of the NHS remains valid as no other system has been shown to work better and at lower cost. The coming ten-year plan must provide details for how the failings documented by Darzi can be rectified. For the NHS, the Labour manifesto commitment to ‘bring about the biggest wave of insourcing of public services’ must be honoured. The important ‘three shifts’ would then become: fund the NHS to succeed rather than to fail; roll back privatisation; reverse the fragmentation of services.
Darzi, A. Independent Investigation of the National Health Service in England.