PM: ‘Major surgery, not sticking plaster solutions’ needed to rebuild NHS

The PM will pledge the ‘biggest reimagining of our NHS since its birth’ in a speech this morning [12 September 2024], following the publication today of a full and independent investigation into the state of the NHS.

Lord Ara Darzi’s probe has concluded the service is in a ‘critical condition’ amidst surging waiting lists and a deterioration in the nation’s underlying health, identifying serious and widespread problems for people accessing services.

The PM will say that the scale of the damage done to the NHS revealed by the report is “unforgivable”, recognising the tragic consequences for too many patients and their families:

People have every right to be angry. It’s not just because the NHS is so personal to all of us – it’s because some of these failings are life and death.

Take the waiting times in A&E. That’s not just a source of fear and anxiety – it’s leading to avoidable deaths.

People’s loved ones who could have been saved. Doctors and nurses whose whole vocation is to save them – hampered from doing so. It’s devastating.

He will also address the causes behind the state of the NHS, including the long term impacts of the 2012 Health and Social Care Act which is described in the report as “a calamity without international precedent” which “proved disastrous”, as well as the far reaching consequences of underinvestment throughout the 2010s. The PM is expected to say:

Our NHS went into the pandemic in a much more fragile state.

We had higher bed-occupancy rates, fewer doctors, fewer nurses and fewer beds than most other high income health systems in the world.

And let’s be clear about what caused that…a “scorched earth” approach to health reform, the effects of which are still felt to this day.

Lord Darzi describes [the 2010s] as “the most austere decade since the NHS was founded”. Crumbling buildings, decrepit portacabins, mental health patients accommodated in Victorian-era cells infested with vermin.

The 2010s were a lost decade for our NHS…which left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow.

As well as recognising the cost to people’s health, the PM will also address the inextricable link between the state of the NHS and the nation’s economy:

It’s not just the state of our National Health Service in crisis – it’s also the state of our national health.

There are 2.8 million people economically inactive due to long term sickness, and more than half of those on the current waiting lists for inpatient treatment are working age adults.

Getting people back to health and work will not only reduce the costs on the NHS, it will drive economic growth – in turn creating more tax receipts to fund public services.

In the face of these dire findings and the growing pressures on the NHS from an ageing society and preventable illnesses, the PM will set out his belief in the ‘profound responsibility’ of government to do the hard work necessary to tackle them:

What we need is the courage to deliver long-term reform – major surgery not sticking plaster solutions.

The NHS is at a fork in the road, and we have a choice about how it should meet these rising demands.

Raise taxes on working people to meet the ever-higher costs of aging population – or reform to secure its future.

We know working people can’t afford to pay more, so it’s reform or die.

Rooted in Lord Darzi’s diagnoses of the challenges facing the NHS, the PM will outline three fundamental areas of reform and the imperative to work with staff and patients throughout this process. He is expected to say:

This government is working at pace to build a Ten-Year Plan. Something so different from anything that has come before.

Instead of the top-down approach of the past, this plan is going to have the fingerprints of NHS staff and patients all over it. 

And as we build it together, I want to frame this plan around three big shifts – first, moving from an analogue to a digital NHS. A tomorrow service not just a today service.

Second, we’ve got to shift more care from hospitals to communities… And third, we’ve got to be much bolder in moving from sickness to prevention.

Only fundamental reform and a plan for the long term can turn around the NHS and build a healthy society. It won’t be easy or quick. But I know we can do it.

The challenge is clear before us; the change could amount to the biggest reimagining of our NHS since its birth.

Lord Darzi is an independent peer and practising surgeon with 30 years’ experience in the NHS. He examined over 600 pieces of analysis from DHSC, NHS England and external organisations during his investigation. His report will inform the government’s 10-year plan to reform the health service.

Lord Darzi said:

Although I have worked in the NHS for more than 30 years, I have been shocked by what I have found during this investigation – not just in the health service but in the state of the nation’s health.

We want to deliver high quality care for all but far too many people are waiting for too long and in too many clinical areas, quality of care has gone backwards.

My colleagues in the NHS are working harder than ever but our productivity has fallen. 

We get caught up frantically trying to find beds that have been axed or using IT that is outdated or trying to work out how to get things done because operational processes are overwhelmed. It sucks the joy from our work – we became clinicians to help patients get better, not to go into battle with a broken system.

We need to rebalance the system towards care in the community rather than adding more and more staff to hospitals. And we need a more honest conversation about performance – the NHS is now an open book.

In the last 15 years, the NHS was hit by three shocks – austerity and starvation of investment, confusion caused by top-down reorganisation, and then the pandemic which came with resilience at an all-time low. Two out of three of those shocks were choices made in Westminster.

It took more than a decade for the NHS to fall into disrepair so it’s going to take time to fix it. But we in the NHS have turned things around before, and I’m confident we will do it again.

Despite the damning analysis, Lord Darzi insists the NHS’s vital signs ‘remain strong’ and he praised staff for their ‘shared passion and determination to make the NHS better for our patients’.

In carrying out the review, Lord Darzi brought more than 70 organisations together in an Expert Reference Group and sought input from NHS staff and patients through focus groups and frontline visits.   

Responding to the report, Secretary of State Wes Streeting said: 

I asked Lord Darzi to tell hard truths about the state of the NHS. He has produced an honest, expert, comprehensive report on the appalling state our health service is in.

Today’s findings will inform our 10-year plan to radically reform the NHS and get patients treated on time again.

The damage done to the NHS has been more than a decade in the making. We clearly have a long road ahead. But while the NHS is broken, it’s not beaten. We will turn the NHS around so it is there for you when you need it, once again.

Today’s report has been welcomed by NHS England and health organisations who have pledged to work closely with the government on its mission to rebuild the NHS.

Amanda Pritchard, NHS England Chief Executive, said:

As this report sets out, staff are the beating heart of the NHS with a shared passion and determination for making the NHS better for patients – but it is also clear they are facing unprecedented challenges.

Our staff are treating record numbers of patients every day despite ageing equipment and crumbling buildings, a surge in multiple long-term illnesses, and managing the long-lasting effects of the pandemic.

While teams are working hard to get services back on track, it is clear waiting times across many services are unacceptable and we need to address the underlying issues outlined in Lord Darzi’s report so we can deliver the care we all want for patients.

As Lord Darzi rightly points out, many of the solutions can be found in parts of the NHS today. That is why we are fully committed to working with government to create a 10-year plan for healthcare to ensure the NHS recovers from Covid, strengthens its foundations and continues to reform so it is fit for future generations.

Key findings from Lord Darzi’s 142-page report include:

• Deterioration: The health of the nation has deteriorated over the past 15 years, with a substantial increase in the number of people living with multiple long-term conditions. 

• Spending: Too great a share of the NHS budget is being spent in hospitals, too little in the community, and productivity is too low.

• Waiting times: Waiting lists have swelled and waiting times have surged, with A&E queues more than doubling from an average of just under 40 people on a typical evening in April 2009 to over 100 in April 2024. 1 in 10 patients are now waiting for 12 hours or more.

• Cancer care: The UK has appreciably higher cancer mortality rates than other countries, with no progress whatsoever made in diagnosing cancer at stage one and two between 2013 and 2021.

• Lasting damage: The Health and Social Care Act of 2012 did lasting damage to the management capacity and capability of the NHS. It took 10 years to return to a sensible structure, and the effects continue to be felt to this day.   

• Productivity: Too many resources have been being poured into hospitals where productivity had substantially fallen, while too little has been spent in the community.