Health Secretary Wes Streeting has warned the NHS could “go bust” if the government does not reform it to account for an ageing society, more sick people and rising costs.
He pledged to spend a greater proportion of the NHS budget on GPs, social care and “community services” than on hospitals, which he said would help alleviate pressure on the service overall.
But the Conservatives said the government needed to turn “rhetoric to action” after scrapping its plans to reform social care and build new hospitals.
The report was the result of a nine-week review by the independent peer and NHS surgeon Lord Darzi.
He was asked by Labour, shortly after the election, to identify the failings in the health service, but his remit did not stretch to coming up with solutions.
His findings present a stark picture of a service which he says is in a “critical condition” and “serious trouble”.
The report from the peer, a surgeon who served as health minister in the last Labour government, said the NHS was still struggling with the aftershocks of the pandemic and falling well short of its key targets for cancer, Accident & Emergency (A&E) and hospital treatment.
It said this was contributing to poor survival rates in cancer and heart disease, and falling rates of satisfaction.
The report said the NHS had been left chronically weakened by the policy of austerity of the 2010s and in particular a lack of investment in buildings and technology. This has left it with crumbling hospitals, fewer scanners than many other developed nations and years behind the private sector in terms of digital innovation.
This has contributed to falling levels of productivity in hospitals, with rises in staff not matched by increases in the numbers of patients being seen.
It has meant hospitals have been sucking up an ever-increasing amount of the budget, when more care should be shifted into the community.
Lord Darzi was also critical of the “disastrous” 2012 reforms introduced by the coalition government, which led to a shake-up of management structure in the NHS and acted as a distraction for the rest of the decade.
‘Ballooning’
It said all this contributed to the NHS entering the pandemic in a depleted state, leading to the cancellation of more hospital treatments than any comparable country and the “ballooning” waiting list, which currently stands at 7.6 million.
Meanwhile, a surge in patients suffering several long-term illnesses, such as diabetes, high blood pressure and respiratory illness, is threatening to overwhelm the NHS alongside soaring levels of mental health problems among young people.
The report says:
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A&E is in an “awful state” – with long waits likely to be causing an additional 14,000 more deaths a year, according to the Royal College of Emergency Medicine
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the state of the NHS is not entirely due to what has happened within the health service, but also because the health of the nation has deteriorated – for example bringing a surge in long-term mental health conditions
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rising levels of illness are risking economic prosperity, with 2.8 million people unable to work because of poor health
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the UK has higher cancer mortality rates than other countries
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although hospital staff numbers have increased since the pandemic, the number of appointments and procedures hasn’t because “patients no longer flow through hospitals as they should”
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the NHS has been starved of capital investment, meaning “crumbling buildings”, mental health patients in “Victoria-era cells infested with vermin” and “parts of the NHS operating in decrepit portacabins”
Lord Darzi said: “Although I have worked in the NHS for more than 30 years, I have been shocked by what I have found during this investigation – not just in the health service, but in the state of the nation’s health.”
Although the report focused on the NHS, Lord Darzi also warned of the “dire” state of social care, which he said was not “valued or resourced sufficiently”.
The growing gap between people’s needs and availability of publicly-funded social care in England was placing “an increasingly large burden on families and on the NHS”, he said.
In a speech this morning Prime Minister Sir Keir Starmer responded to the report by promising “the biggest reimagining of the NHS” since it was formed, with a new 10-year plan for the health service to be published in the coming months.
He proposed three key areas of reform: the transition to a digital NHS, moving more care from hospitals to communities and focusing efforts on prevention over sickness.
Sir Keir said Lord Darzi’s report was a “raw and honest assessment” of the NHS. Nearly a tenth of all patients wait 12 hours or more, leading to thousands of avoidable deaths, he said.
“It’s devastating, heart-breaking, infuriating,” the PM added.
Speaking to BBC Breakfast, Mr Streeting added that primary care and community services would be “the first port of call” for new money – not hospitals.
“Rather than a country with an NHS, we’re going to have an NHS with a country attached to it if we’re not careful, and more likely an NHS that goes bust,” the health secretary said.
Streeting also pledged to deliver “schemes” from the previous government’s New Hospitals Programme – but said it may be over a longer timeframe.
‘Deeply troubling’
Matthew Taylor, the head of the NHS Confederation, which speaks on behalf of NHS organisations and their 1.5 million employees, told the same programme the report had identified some of the problems facing the health service.
But he warned that waiting lists would probably get even longer this winter – as normally happens.
“It will take at least a full term for Labour to get anywhere near the kinds of targets they’ve got for waiting lists”, he said.
Thea Stein, chief executive of the Nuffield Trust think tank, said while Lord Darzi’s report was “not surprising” it was still “deeply troubling”.
“The big question now is what happens next.”
Healthwatch England response
Healthwatch England’s Head of Policy William Pett said: “People will welcome Lord Darzi’s prognosis on the NHS. Although the NHS does much good, patients repeatedly share their frustrations and confusion about accessing care.
“GP access is difficult, NHS dentistry is in disarray, and people face excessive waiting times for hospital treatment. These challenges are not experienced equally, with poorer communities hit hardest. Restoring public confidence in the NHS and delivering timely, safe and quality care must focus on the issues that matter most to people now and in the future.
“We’re calling for improvements to patient communications and administration, giving people a choice of how to access care, a better listening culture within the NHS, and for services to be measured against the quality of patient experiences, not just the length of time they wait for care.
“The public will welcome the chance to help shape the future of healthcare and reset the contract between them and the NHS. Especially if it results in clearer rights, more responsive services and an equal say in their care.”
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