Conservative health reforms have left UK vulnerable to Covid disaster, top doctor’s report says

Britain was hit much harder by the Covid-19 pandemic than other developed countries because the NHS was “severely weakened” by disastrous government policies of the previous decade, a major report concludes this week.

A review of the NHS by world-renowned surgeon Prof Ara Darzi, commissioned by Health Secretary Wes Streeting in July, found that the health service has reduced its “routine healthcare activities by a much greater percentage than other health systems” in many key areas during the Covid crisis.

For example, hip and knee replacements fell by 46% and 68% respectively. Hospital discharges as a whole fell by 18% between 2019 and 2020 in the UK, compared with the Organisation for Economic Co-operation and Development average of 10%, Lord Darzi will say.

In a key part of his report, the independent peer will also conclude that the NHS is still struggling with the aftermath of its failure to respond adequately to the Covid shock at the time.

“The current state of the NHS cannot be understood without acknowledging how much care has been cancelled, halted or postponed during the pandemic… The impact of the pandemic was magnified by the fact that the NHS had been severely weakened in the decade leading up to its onset.”

Darzi will be particularly critical of the top-down reorganisation of the NHS by former Conservative health minister Andrew Lansley under David Cameron’s premiership, which he says has “scorched the earth on health reform”.

“The Health and Social Care Act 2012 was a disaster without international precedent – ​​it proved disastrous,” Darzi will say, adding: “The result of the disruption was a permanent loss of capacity in the NHS… This is a significant part of the explanation for the deterioration in the performance of the NHS as a whole.

“Rather than liberating the NHS as promised, the Health and Social Care Act 2012 has trapped more than a million NHS staff in a broken system for the best part of a decade.”

Lord Lansley defended his reforms, saying Darzi should focus on the “here and now” rather than hark back to a decade ago with the “blame the Tories” narrative.

“The 2012 Act created NHS England. It gave the NHS more power. It cut administration costs by £1.5 billion. Waiting times were reduced to the lowest level. The longest waiting times were virtually eliminated,” Lansley said. He added that if his plans had been fully implemented they would have made the NHS more competitive internationally.

The Conservatives are preparing to criticise the Darzi report, alleging it is politically motivated, as its author was a minister in the previous Labour government and was a member of the Labour Party until he resigned in 2019.

However, Labour will point to his impressive CV and the fact that he held prominent positions while the Tories were in power, including serving as the UK’s global ambassador for health and life sciences from 2009 to March 2013. Darzi was also appointed non-executive director of the NHS regulator Monitor in 2015, which oversaw quality and performance management of healthcare in England.

The Darzi report – which also found that more than 100,000 babies (aged 0-2) in England last year had to wait more than six hours in emergency departments – is being hailed as a watershed moment by senior NHS officials.

Streeting is expected to use the report as the basis for its own blue-sky thinking on reform. The current NHS England long-term plan, introduced in 2019, was drawn up before the pandemic, which has seen waiting lists lengthen to a point where 6.39 million people are waiting for 7.62 million treatments.

Streeting said last year he believed the NHS needed three major shifts: from disease to prevention, from hospitals to GPs and community services, and from an “analogue service to a service that embraces the technological revolution”.

Two other major reports being released this week also paint a bleak picture of the outlook for health care under current limited spending.

A survey of trust chief executives and finance directors by NHS Providers, the membership organisation for users of hospital, mental health, community and ambulance services, has found that more than half (51%) are “extremely concerned” about their ability to deliver their priorities within the tight financial constraints set for 2024-25.

Nine out of ten found the financial situation more challenging than last year. Measures they were asked to consider included “extending hiring freezes”, “reducing the number of substantial staff” and “scaling back services”.

Sir Julian Hartley, chief executive of NHS Providers, said the message was that with funding so tight, ways needed to be found to secure multi-year investment in reforms that would boost productivity, “rather than this stop-start approach to NHS funding, which has them constantly worrying about cuts followed by quick fixes, short-term funding announcements”.

Furthermore, a report by the NHS Confederation and healthcare consultancy CF (Carnall Farrar) has found that Labour’s pledge to create 40,000 extra appointments a week in England will not stop waiting lists from continuing to rise.

It would deliver just 15% of what is needed to ensure 92% of patients start routine hospital treatment within 18 weeks – a key target that has not been met for almost a decade.

NHS Confederation chief executive Matthew Taylor said waiting lists were unlikely to reduce significantly before spring or summer next year.

He added: “We have to be realistic about the fact that unless we do some pretty transformative things, demand will grow substantially. Almost everyone agrees that we need to transform the NHS by investing in prevention. To do that you have to double down (open new services before old ones close).

“None of these things can be achieved for free. What we need from Rachel Reeves is a recognition that the long-term sustainability of health care, the public sector and the economy as a whole, rests on shifting the demand curve for health care.”