Even when we take into account the many manifestations of the deep crisis of the NHS in recent years, some of Lord Ara Darzi’s findings in his assessment of the state of the service are striking. The emergency department is in such a “terrible state” that thousands of people die every year because they are not seen quickly enough.
“Starving” the service of vital capital funding has left “dilapidated buildings, psychiatric patients housed in vermin-infested Victorian-era cells, with 17 men sharing two showers, and parts of the NHS operating in dilapidated mobile buildings”. Efforts to improve early cancer diagnosis have made “no progress whatsoever… between 2013 and 2021”, despite the fact that so many lives depend on it.
But Darzi’s report is more than just a litany of NHS doom. Like any good doctor, he has not only identified what ails his patient, but also laid out his treatment plan to restore him to health. Despite concluding that the NHS is “in critical condition”, he adds reassuringly that “vital signs are strong”. To make his case, he cites the service’s “extraordinary depth of clinical talent”, the “shared passion and determination of staff to make the NHS better for our patients” and the fact that “the NHS has more resources than ever before”.
On waiting times, he is hopeful that things will eventually improve. The ex-Health Secretary (2007-10) is one of a number of veterans of the Blair/Brown years who helped rescue the NHS from its weakened state after years of Tory rule and who are now helping Keir Starmer and Wes Streeting repeat the trick. They include Alan Milburn, who is now advising Streeting, and Paul Corrigan, another adviser who is now drawing up Labour’s promised 10-year plan for the NHS. His assertion that “just as we have improved performance in the NHS before, we can do it again” is therefore a resolute voice of experience, not a bluff.
Streeting asked the cancer surgeon to make his report a roadmap for the 10-year plan, due next spring. It recommends that, with so many staff feeling so “disconnected” after Covid, NHS staff need to be re-engaged and re-energised. That’s vital for its own sake, but also because without happier staff the NHS can’t solve its productivity puzzle – namely, that despite record staff numbers and its biggest-ever budget, productivity has fallen. Improved pay should help, but better working conditions are also needed.
Darzi’s mandate did not allow him to recommend a bigger budget or specify exactly how much more money might be needed in the coming years to get the NHS back on its feet. But his report is clear that the NHS needs far more capital funding, to buy new scanners and replace some of the many dilapidated, sometimes dangerously archaic, facilities in which it provides care. Others, such as the NHS Confederation, have called for a £7bn boost in capital spending. Will that be forthcoming?
Money is the elephant in the room of Darzi’s impressive document. For example, creating a “neighbourhood NHS”, by moving care from hospitals to the community, will inevitably require more money, not least to cover the costs – albeit temporarily – of what health nerds call the “dual running” of old and new services until the latter are established. Will it be available?
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As the new government grapples with the toxic financial legacy left by its predecessor, the NHS, which Labour claimed was the Tories’ most compelling example of “broken Britain”, looms as not only the most urgent problem to fix, but also the most expensive.