Three reports expose the scale of the NHS’s malaise. But will Rachel Reeves fund a transformation? | James Tapper and Toby Helm

The diagnosis was made quickly. Lord Darzi took just nine weeks to deliver his report on the state of the NHS. The treatment is likely to be much longer and more painful.

Wes Streeting’s first major act as Health Secretary was to appoint the eminent surgeon, nicknamed Robo Doc for his use of robots in operations, to reveal “hard truths” about the NHS in England. What Darzi concludes is expected by many to form the basis of Labour’s plans for treating an ageing and sicker population – without bankrupting the nation.

Existing NHS plans were drawn up under Theresa May’s government and published before Covid compounded the problems. Waiting lists were already growing before March 2020 but soared to almost 8 million after the pandemic hit, hospitals are crumbling and long-term sick leave has soared, with 2.8 million people out of work, 900,000 more than in 2019.

But perhaps the biggest challenge is that there are now 11 million over-65s in the UK, up from 9.2 million in 2011, and older people are increasingly in need of care. A report out today from consultancy Carnall Farrar (CF) warns that if demand continues to grow at the current rate, the NHS could be doing 50% more work than it does today by 2029.

Even if Labour delivers on its promise to deliver 40,000 extra appointments a week, it will not be enough to stop waiting lists getting longer.

“The NHS needs reform, not just more activity,” said Matthew Taylor, chief executive of the NHS Confederation. “This means moving to earlier, more preventative services, including primary and community care, to slow the rise in demand. It also means increasing productivity through modern technology and buildings and equipment fit for the 21st century.”

But that means spending money. A survey by NHS Providers, which represents hospital leaders, found that 44% do not think they have enough money to run their current services. Some are reducing staff and “even having to consider scaling back services”.

Sir Julian Hartley, chief executive of NHS Providers, said: “This research highlights the huge financial pressures the NHS is currently under. Trust leaders are facing some really tough decisions.”

Trusts are trying to get staff to work longer by paying 1.5 times the hourly rate for weekend and evening shifts, and leaders hope that digital tools such as the controversial Federated Data Platform, which shares patient information, will help. But that “can only go so far without significant strategic investment in infrastructure and digital technologies”, Hartley said.

“There are really deep-seated concerns about NHS funding and how that pressure is increasing. It’s never been so tough. But they also show how the right support and leadership can make a difference.”

Rachel Reeves may need convincing to find extra money to fund an NHS transformation. This week, fingers will be collectively crossed that she and Keir Starmer are convinced by Darzi’s report.