In a letter to the UK's Health Secretary of State, Lord Darzi summarises his conclusions from his rapid investigation of the state of the NHS, assessing patient access, quality of care and the overall performance of the health system. (The Secretary of State for Health - Wes Streeting - had asked Lord Darzi to undertake such a review).
I think the report is clear in its analysis and recommendations. Perhaps due to the brief Lord Darzi was given, his report does not address the question of how such a culture change in such a large organsation can be managed over the many years it will take. In researching such I fell upon this NHS document.
Lord Darzi's conclusions are summarised below.
1) The Health Service is in serious trouble, public satisfaction with it is at its lowest ever.
2) He's worked in the NHS for over 30 years & was shocked by what his investigation found.
3) Causes? Whats happened within the NHS plus a deterioration in the nations's health.
4) The report sets out where the NHS stands now, how we got here and some key remedies.
5) The NHS hasn't met its promises made to people since 2015 on waiting times & treatment.
6) People are struggling to see their GP, shortages are acute in deprived communities.
7) More than 1m people have long waits for community services & mental health.
8). A&E is in an awful state with longer waiting times likely causing 14k more deaths p.a.
9) Waiting times for hospital procedures have ballooned (2010 20k over a year, 2024 300k)
10) The UK has appreciably higher cancer mortality rates than other countries.
11) Care for cardiovascular conditions are going in the wrong direction.
12) Once people are in the system, they get high quality care but maternity care is a concern.
13) Productivity is low, with too much of NHS £ spent on hospitals, too little in the community.
14) NHS isn't contributing to national prosperity as it could by reducing long term sickness.
(Four heavily inter-related factors have contributed to the current dire state of the NHS. They are austerity in funding and capital starvation; the impact of the Covid-19 pandemic and its aftermath; lack of patient voice and staff engagement; and management structures and systems)
15) Spending is below the 2018 funding promise and the historic rate its based on.
16) The NHS has been starved of capital resulting in crumbling buildings that hit productivity.
17) On top of 16) there is a £38b shortfall of capital investment in buildings & equipment.
18) Capital starvation & COVID means the NHS backlog is bigger than other health systems.
19) A familiar theme in care failings is patients’ concerns not being heard or acted upon.
20) Post pandemic too many staff are disengaged with high levels of sickness absence.
21) The 2012 changes to the NHS structures were a calamity without international precedent.
22) The 2012 changes meant constant reorganisation of NHS HQ & regulatory functions.
(NHS organisations should focus on the patients and communities they serve, but the sheer number of national organisations that can ‘instruct’ the NHS encourages too many to look upwards rather than to those they are there to serve. The Care Quality Commission – which inspects the NHS – is not fit for purpose, as the recent independent review made clear. Its focus on inputs rather than outcomes has played a major role in driving up the numbers of clinicians in hospitals to unprecedented levels.)
23) The NHS is in critical condition
(It continues to struggle with the aftershocks of the pandemic. Its managerial capacity and capability have been degraded, and the trust and goodwill of many frontline staff has been lost. The service has been chronically weakened by a lack of capital investment which has lagged other similar countries by tens of billions of pounds. All of this has occurred while the demands placed upon the health service have grown as the nation’s health has deteriorated).
24) This isn't primarily due to a failure of NHS management.
(The NHS is the essential public service and so managers have focused on “keeping the show on the road”. Some fantasise about an imaginary alternative world where heroic NHS managers were able to defy the odds and deliver great performance in a system that had been broken. Better management decisions might have been taken along the way, but I am convinced that they would have only made a marginal difference to the state that the NHS is in today.)
25) But the NHS’s vital signs remain strong - clinical talent, staff's belief in NHS values.
26) NHS Vision OK - Taxpayer funded, free at point of use, based on need not ablility to pay.
(With the exception of the United States, every advanced country has universal health coverage – and the rest of the world are striving towards it. But other health system models – those where user charges, social or private insurance play a bigger role – are more expensive, even if their funding tends to be more stable. It is not a question, therefore, of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around)
27) Over 10 years the NHS has fallen into disrepair, improving it will take more than 5 years.
28) Major themes for the forthcoming 10-year health plan - should be ........
a) Re-engage staff and re-empower patients.
b) Lock in the shift of care closer to home by hardwiring financial flows that encourage such.
c) Simplify and innovate care delivery for a team work multidisciplinary neighbourhood NHS.
d) Acute care providers should bring down waiting lists by radical productivity improvement.
e) Tilt towards technology/digital systems/AI to unlock productivity.
f) Spending £165b the NHS's productivity is vital for national prosperity.
g) Clarify roles, strengthen capital approval processes & balance management resources.
h) Change will only be successful if the NHS recovers its capacity to deliver plans.
Photo by nicolasjleclercq via unsplash
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