Independent Investigation into the state of the NHS in England – “the NHS is in critical condition, but its vital signs are strong”

The report published by Lord Darzi sets out key findings as to the state of the NHS in England and identifies major themes for the forthcoming 10-year heath plan. 

The findings of the independent investigation of the NHS in England undertaken by Lord Darzi was published on 12 September 2024 (the “Report”). The investigation was commissioned earlier this year by the Secretary of State for Health and Social Care to consider patient access to healthcare, the quality of healthcare being provided and the overall performance of the health system.

The Report does not paint a new picture of the state of the NHS and recognises and re-enforces many long-standing existing concerns – perhaps unsurprisingly so, as Lord Darzi’s last review of the NHS came only 6 years ago which prompted a ten-point improvement plan. 

A key message from the Report is that the current state of the NHS is not due to a sole determining factor but is a result of a multitude of factors including socio-economic decline and lack of capital investment in NHS assets, technology and staffing. 

The findings of the report are wide-ranging and include:

• Waiting times: waiting time targets are being missed across a full spectrum of NHS services ranging from GP access, community services, A&E to cancer and cardiac services.

There are also increased waiting times for mental health services with 1 million people waiting for mental health services by April 2024.

• Mixed quality of care: the Report concluded that once people are within the system the quality of care received is high however, this not the case for all areas such as maternity care which is an area of concern.
• NHS budget is not being spent where it should be: too much of the NHS budget is being spent on hospitals and the Report concludes that more funding is needed in community services to help keep people out of hospital and to facilitate discharge for patients who require follow-on care.

The Report also recognises that productivity in the NHS has fallen. Whilst there has been growth in the number of hospital staff, the number of appointments, operations and procedures has not increased at the same rate. 

• Funding: the combination of austerity in the 2010s, the NHS being starved of capital (e.g. the NHS using capital to cover in-year deficits) and shortfalls in capital investment has significantly impacted the NHS resulting in assets not being fit for purpose and a missed opportunity for the NHS to embrace existing and new technologies to improve care delivery. The impact on funding also has a circular effect impacting the services being delivered to patients.
• Covid-19: the impact of the Covid-19 pandemic on the NHS is well-known but the Report highlights that “the NHS delayed, cancelled or postponed far more routine care during the pandemic than any comparable health system” contributing to the backlog in the health system.
• Patient engagement: patient satisfaction with the NHS is at an all time low with the number of complaints being made increasing. The Report identified a familiar theme that patients’ concerns are not being heard or acted upon with £3 billion or 1.7% of the NHS budget being spent on compensation for care failures.
• Staff engagement: staff are disengaged with high levels of sickness absence.

Despite the focus on the array of NHS shortcomings, the Report is optimistic that the NHS can be improved in time.

The Report concluded with identifying key themes to help inform the forthcoming 10-year health plan as follows:

1. Re-engage staff and re-empower patients.
2. Lock in the shift of care closer to home by hardwiring financial flows: funding needs to enable general practice, mental health and community services to expand and adapt to the needs of patients with long-term conditions.
3. Simplify and innovate care delivery: the NHS needs to work as a team and embrace new multidisciplinary models of care.
4. Increase productivity: increased productivity in hospitals will require better operational management, capital investment in NHS assets and re-engage and empower staff.
5. Technology: there needs to be a shift towards technology to improve productivity including through AI to transform care.
6. Contribute to the nation’s prosperity: productivity in the NHS is vital for national productivity and the NHS needs to help people get back to work.
7. Reform to make the structure deliver: whilst the Report does not propose a re-organisation of the NHS management structure (recognising that the changes brought about the  Health and Care Act 2022  (e.g. introduction of Integrated Care Boards) makes for a sensible management structure) there is more work done to be done to clarify roles, accountabilities and the right balance of management resources throughout the NHS.

If you would like to discuss any of the above please contact a member of our Healthcare team.

This article was written by Lisa Mulholland and Patrick Parkin.