The dire state of the NHS after more than a decade of neglect has been laid bare but the situation can be recovered and there remain strong vital signs within the service, according to Lord Ara Darzi.
Struggles to see GPs, growing waiting lists for mental health and hospital procedures, lagging cancer care and cardiovascular treatment and failure to meet the most important targets since 2015 were among the key performance issues raised.
Lord Darzi (pictured) also highlighted that the overall health of the nation and social determinants of health such as housing, income and employment had worsened over the last 15 years, with these further hurting NHS performance.
His report is damning of the 15 years of Conservative government and highlights the years of austerity for massive underfunding, broken promises and capital budgets being used to fill day-to-day gaps which ultimately led to crumbling NHS infrastructure.
There is also a call for the health service to focus more on prevention and providing care in community settings rather than hospitals.
Time to repair but reinforces public-funded health
Ultimately, Lord Darzi warns that it has taken more than a decade for the NHS to fall into disrepair so improving it will take time.
“Waiting times can and must improve quickly. But it will take years rather than months to get the health service back to peak performance,” he said.
“I have no doubt that significant progress will be possible, but it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term.”
But he does not see it as condemnation of the public funded system, instead suggesting other health system models, where user charges, social or private insurance play a bigger role, are more expensive, even if their funding tends to be more stable.
“Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use, and based on need not ability to pay,” he said.
“It is not a question, therefore, of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around.”
Performance failings outlined
Lord Darzi was commissioned by the newly elected Labour government to uncover the state of the NHS which the 163-page report reveals in stark detail.
Some of the key points relating to poor performance raised include:
- It is inevitable that public trust and confidence will have been damaged by the inability of the NHS to meet the promises of the NHS constitution.
- By April 2024, about one million people were waiting for mental health services and long waits have become normalised with 345,000 people waiting more than a year for first contact with mental health services – more than the entire population of Leicester – and 109,000 of those were for children and young people under the age of 18.
- In 2010, 94% of people attending a type 1 or type 2 A&E were seen within four hours; by May 2024 that figure had dropped to just over 60%. More than 100,000 infants waited more than six hours last year and nearly 10% of all patients are now waiting for 12 hours or more.
- According to the Royal College of Emergency Medicine, these long waits are likely to be causing an additional 14,000 more deaths a year – more than double all British armed forces’ combat deaths since the health service was founded in 1948.
- In March 2010, there were just over 2.4 million people on the hospital procedures waiting list, of whom 200,000 had been waiting longer than 18 weeks. Of those, 20,000 had waited more than a year. By contrast, in June 2024, more than 300,000 had waited over a year, and 1.75 million had been waiting for between six and 12 months. Although one recent improvement is that only some 10,000 people are still waiting longer than 18 months, a sharp fall from 123,000 in September 2021.
- While survival rates at one year, 5-years and 10-years have all improved, the rate of improvement slowed substantially during the 2010s. The UK has appreciably higher cancer mortality rates than other countries. No progress whatsoever was made in diagnosing cancer at stage I and II between 2013 and 2021. The 62-day target for referral to first treatment has not been met since 2015 and in May 2024, performance was just 65.8%. More than 30% of patients are waiting longer than 31 days for radical radiotherapy.
- 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.
- NHS productivity has slowed due to falling capital spending. The number of appointments, operations and procedures, has not increased at the same pace as staff numbers and so productivity has fallen. A desperate shortage of capital prevents hospitals being productive. And the dire state of social care means 13% of NHS beds are occupied by people waiting for social care support or care in more appropriate settings.
Conservatives’ austerity and reforms blamed
The main reasons for these collapse in standards and patient outcomes is laid at four key elements, with the Conservative government’s funding cuts and 2012 reforms highly blamed.
They are 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.
These critical points include:
- The 2010s were the most austere decade since the NHS was founded; until 2018 spending growing at around 1% in real terms against the long-term average of 3.4%. Adjusted for population growth and changes in age structure, spending virtually flatlined. The 2018 promise of 3.4% per year did not include capital spending, medical training, nor any increase in public health expenditure, and was broken as it did not reach 3%.
- The NHS has been starved of capital and the capital budget was repeatedly raided to plug holes in day-to-day spending. Some £4.3bn was raided from capital budgets between 2014-15 and 2018-19 to cover in-year deficits that were themselves caused by unrealistically low spending settlements. The backlog maintenance bill now stands at more than £11.6bn and is resulting in crumbling buildings and outdated diagnostics.
- Furthermore there is a shortfall of £37bn of capital investment.
- The combination of austerity and capital starvation helped define the NHS’s response to the pandemic. The impact of the pandemic and its aftermath created a bigger backlog than other health systems.
- The patient voice is not loud enough and a familiar theme in inquiries into care failings has been patients’ concerns not being heard or acted upon.
- There is also compelling evidence that, post-pandemic, too many staff have become disengaged, and there are distressingly high-levels of sickness absence.
Seven themes to repair NHS
However, Lord Darzi highlighted seven important themes on how to repair the NHS, which will need to be considered alongside strategies to improve the nation’s health and reforms to social care.
These are to:
- Re-engage staff and re-empower patients,
- Lock in the shift of care closer to home by hardwiring financial flows,
- Simplify and innovate care delivery for a neighbourhood NHS,
- Drive productivity in hospitals,
- Tilt towards technology,
- Contribute to the nation’s prosperity,
- Reform to make the structure deliver.