There are few surprises in Lord Darzi's review of the National Health Service, not least because much of it has already leaked out. Health Secretary Wes Streeting declared immediately after Labour won the election that the NHS was 'broken'. Darzi, a surgeon and former Labour health minister whom Streeting commissioned to undertake the probe, appears to have reached a similar conclusion in today's report, though not in as few words.
'We have crumbling buildings, mental health patients being accommodated in Victorian-era cells . . . and parts of the NHS operating in decrepit portacabins,' Darzi says. His diagnosis is that Britain has underspent on health assets and infrastructure in the NHS by some £40 billion compared to similar countries over the last 15 years. This has, unsurprisingly, had a profound and negative effect on modernisation and care backlogs. The failure to invest in up-to-date equipment like MRI machines and CAT scanners has prevented clinicians from making major inroads into waiting lists for routine care. Patients across Britain are paying the price.
Worryingly, however, despite this inability to provide adequate resources for land, buildings and equipment, England spends a comparable amount of money on healthcare to peer countries like Germany, France and Australia: the NHS receives nearly 11 per cent of GDP, set against an OECD average of 9.1 per cent. Bluntly, we are spending the same amount of money for worse outcomes and facilities.
Another major problem has been industrial action. Since 2022, there has been a wave of strikes over pay by nurses, ambulance workers, junior doctors and other NHS staff. These stoppages are estimated to have led to the cancellation of 1.5 million appointments and operations, exacerbating waiting lists and delays.
Streeting has the review he asked for, but the government must now address the enormous challenges to the provision of healthcare that it has highlighted. Keir Starmer has defused the issue of industrial action by awarding an above-inflation 5.5 per cent pay rise to all NHS staff employed on Agenda for Change contracts. This is unlikely to be a long-term fix: the general secretary of Unison, Christine McAnea, has warned: 'This year's pay rise cannot be a one-off. It'll take much more than this boost to get the NHS into a better place.' Even so, the current pay award will cost at least half-a-billion pounds, and general practitioners are still threatening industrial action.
With the chancellor, Rachel Reeves, intoning the necessity of taking 'tough decisions', the chances of significant additional spending in October's Budget must be next to zero. Although Labour's manifesto declared that it was 'committed to delivering the New Hospitals Programme', the party has paused the scheme to build 40 new hospitals in order to 'review' it.
The Department of Health has stressed that 'the challenges facing the NHS aren't about money alone, but how money is often not spent effectively'. It adds that 'reform is crucial to make taxpayers' money go further'. Sadly, there seems to be a dearth of detail on what this 'reform' might look like. Streeting has spoken airily of three 'shifts' in the health service, from 'hospital to community', from 'analogue to digital' and from 'treatment to prevention'.
How are these shifts to be achieved, and how much will they cost? Moving from 'analogue to digital' surely requires investment in new technology, while the introduction of Care in the Community in mental health decades ago demonstrated that an outpatient-focused, community-based model was often more, not less, expensive. Prevention, meanwhile, is a long-term process of early intervention and behaviour change, with no quick wins or immediate savings.
Starmer has said that Darzi's NHS review shows 'that the NHS is broken but not beaten'. Labour has spent much of its time since coming to power pointing the finger at the Tories. It's time to end the blame game - and start doing something to fix the NHS's many problems. Perhaps the government has a cunning plan. If Streeting can achieve dramatic improvements in care quality and outcomes through reform without enormous investment, he will be as much in demand as if he had achieved perpetual motion.