The Guardian view of the NHS: the biggest test for Starmer’s government | Editorial

By Liam On Sep 12, 2024

Iord Darzi has given Keir Starmer’s government a concise and clearly argued account of the problems facing the NHS in England. Some of his findings, such as those on waiting lists, are familiar. The themes and conclusions – for example, the underfunding of primary care relative to hospitals, and the rise of obesity and chronic disease – are broadly as expected. But this is a valuable piece of work by a respected doctor, and a significant step towards the 10-year plan that Labour has promised next year.

It describes how record-high public satisfaction with the NHS in 2009 was reduced to a record low by cuts. It explains how the funding promise made on the service’s 70th anniversary in 2018 was broken. And it describes how inequalities in the availability and delivery of healthcare mean that poorer people, ethnic minorities and people with mental health conditions are particularly poorly served.

Underfunding is not the only problem facing the NHS. Midwives in England deliver fewer babies than in other European countries, yet outcomes are worryingly unequal. Here, and in relation to patient safety more broadly, Lord Darzi highlights serious concerns around leadership and culture. But the report does not shy away from the devastating consequences of the Conservatives’ failure to fund buildings and equipment. It describes this refusal to invest as “capital starvation” and notes a “staggering gap” with other countries.

The report makes no bones about the chaos unleashed by Andrew Lansley’s radical restructuring, imposed despite a pledge from David Cameron to avoid top-down reorganisation. More than a decade later, it concludes that the NHS is still recovering from the dissolution of its management, calling it “a disaster without international precedent”. Even after the mistake was acknowledged and reforms partially reversed, Conservative ministers could not resist further upheaval, abolishing the key public health body in the midst of the pandemic. Coming barely a week after the Grenfell inquiry’s attack on the deregulation agenda pursued under Cameron, this inquiry is further evidence of the damage wrought by 14 years of Tory government.

The new, regional structure is seen as more sensible. But here too problems are identified, with integrated care boards not being clear about their role and in need of clearer direction. Nor is regulation working as it should, with the number of people in standards and regulatory roles multiplying without useful purpose. At its worst, oversight is distracting from the clinical focus, while the different accountability measures in hospitals and community services are a reason why resources continue to drain away from the latter. Like Wes Streeting, Lord Darzi believes the Care Quality Commission is not fit for purpose.

Sir Keir’s soundbite on Thursday that the NHS must “reform or die” was stark. The country will always need its health service, just as it needs prisons and schools. Workplace challenges, including absenteeism, are among the sector’s most pressing issues, and the morale of both staff and patients must be addressed.

The remit of this review was not to make recommendations. Ministers did not want a prescription, only a diagnosis. But Lord Darzi does make one, namely that funding streams should be “fixed”, presumably in law, if community care is to receive a greater share of the overall health budget – as Mr Streeting has said he is determined to do. Ministers will have to consider this in drawing up their response to the report.

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