On 25 September, the UK Department of Health published a review of National Health Service performance in England by the prominent surgeon Lord Ara Darzi [1]. This was commissioned by the Secretary of State for Health in July, following the electoral victory of the Labour party, presented as a stock-take of their inheritance from the previous Conservative party government [2].
The report warned that the English National Health Service (NHS) is “in serious trouble”, with a crisis marked by unprecedented public dissatisfaction, poor access to care, and declining health outcomes. It also made recommendations for a forthcoming 10-year plan for the service, expected in 2025 following a public engagement process.
Waiting times for GP appointments, community services, and mental health care have surged, with millions waiting for treatment, particularly among vulnerable populations like children. The NHS has not met key performance targets since 2015, leading to further erosion of public confidence. Cancer survival rates remain below those of comparable countries, and the rate of inclusion has slowed over the last 15 years. Despite recent increases in staffing, productivity appears lower than before the COVID-19 pandemic, which has left a difficult legacy of higher need, staff stress, and delayed treatment.
Lord Darzi noted that deteriorating population health, associated with worsening of the social determinants of health, such as housing and income, had exacerbated the situation. The report also pointed to diminished and limited managerial capacity, praising management generally for attempting to “keep the show on the road”, and to a lack of capital investment. It concluded that the move to “Integrated Care Boards” bringing together purchasers and providers “has the makings of a sensible management structure” and applauded the shift towards collaboration over competition. However, it noted that despite attempts to shift care from hospitals to community and primary care, spending and staffing had become even more concentrated in hospitals.
Specific policy recommendations were outside the report’s scope, but it provided a set of themes for a comprehensive 10-year health plan to address systemic issues and strengthen the NHS. These were:
- Re-engage staff and re-empower patients.
- Lock in the shift of care closer to home by hardwiring financial flows, reflecting a government commitment to expanding the share of the budget spent outside hospital.
- “Simplify and innovate care delivery for a neighbourhood NHS”, with multidisciplinary care across primary, community and mental health care.
- Drive productivity in hospitals through better management and capital investment.
- Improve the use of technology, particularly by expanding electronic records and digital data to services outside hospital, and by adopting AI.
- Contribute to the nation’s prosperity by reducing the number of people economically inactive due to health needs.
- Clarify roles and accountabilities, rebalance management capacity, and improve capital approvals so that the health service is better able to deliver on policies.