The three changes that need to happen to save the NHS
The Prime Minister has laid out the vital need for radical reform in the NHS following a report into the ‘critical condition’ of the health service.
Sir Keir Starmer said the government could not afford to try and fix the wide array of issues by simply pumping in cash, and a series of dramatic changes must be made.
He set out his plans for tackling long waiting lists, improving the nation’s health, and shifting the focus towards community services after a scathing report from Lord Darzi found the NHS in England is ‘in serious trouble’.
Wes Streeting, the health secretary, has said the report – which was released this morning – highlighted the three major changes the institution should urgently make to save it.
He has said they are:
- Shifting from hospital to community care
- Changing from analogue to digital
- Moving from treating sickness to preventing it
Streeting said work to resolve the challenges facing the NHS must start immediately, though a 10 year plan outlining the government’s approach to the reforms will not be published until spring next year.
He also warned the health service could ‘go bust’ if the government doesn’t ‘grasp both the immediate challenge in front of us and deal with the crisis today but also prepare the NHS for the challenges of the future’.
He told BBC Breakfast it is also in terms of ‘an ageing society and disease and rising costs, rather than a country with an NHS’.
He added: ‘We’re going to have an NHS with a country attached to it if we’re not careful, and more likely an NHS that goes bust.
‘That’s not the future we want to see, which is why we’re going to deal with the immediate crisis today, but get the NHS back on its feet and make it fit for the future.’
The rapid review, completed in nine weeks, diagnoses the problems in the NHS and sets out themes for the government to incorporate into a 10-year plan for reforming the health service.
It argues the NHS is facing rising demand for care as people live longer in ill health, coupled with low productivity in hospitals and poor staff morale.
Speaking at an event in London this morning, the Prime Minister said: ‘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 an ageing population – or reform to secure its future.
‘We know working people can’t afford to pay more, so it’s reform or die.’
What are the key findings from the Darzi Report?
Lord Darzi’s report also set out how:
• The health of the nation has deteriorated, with more years spent in ill health.
• Factors affecting health, such as poor quality housing, low income and insecure employment, ‘have moved in the wrong direction over the past 15 years, with the result that the NHS has faced rising demand for healthcare from a society in distress’.
• There has been a ‘surge’ in multiple long-term conditions, including a rise in poor mental health among children and young people. Fewer children get their vaccines and fewer adults now participate in things such as breast cancer screening.
• Waiting times targets are being missed across the board, including for surgery, cancer care, A&E and mental health services. The report says ‘long waits have become normalised’ and ‘A&E is in an awful state’. By April 2024, about one million people were waiting for mental health services. The overall NHS waiting list stands at 7.6 million.
• People are struggling to see their GP. ‘GPs are seeing more patients than ever before, but with the number of fully qualified GPs relative to the population falling, waiting times are rising and patient satisfaction is at its lowest ever level.’
• Cancer care still lags behind other countries and cancer death rates are higher than in other countries. There was ‘no progress whatsoever’ in diagnosing cancer at stage I and II between 2013 and 2021. However, more recent figures show some improvement.
• Progress in cutting death rates from heart disease has stalled while rapid access to treatment has deteriorated. For example, the time for the highest-risk heart attack patients to have a rapid intervention to unblock an artery has risen by 28% from an average of 114 minutes in 2013-14 to 146 minutes in 2022-23.
• The NHS budget ‘is not being spent where it should be’ and too great a share is being ‘spent in hospitals, too little in the community, and productivity is too low’. Too many hospital beds are taken up with people needing social care.
• Between 2009 and 2023 the number of nurses working in the community fell by 5%, while the number of health visitors dropped by nearly 20%.
• At the start of 2024, 2.8 million people were economically inactive due to long-term sickness, with most of the rise since the pandemic down to mental health conditions. The report said ‘being in work is good for wellbeing’ and having more people in work grows the economy. ‘There is therefore a virtuous circle if the NHS can help more people back into work.’
• Raids on capital budgets have left the NHS with crumbling buildings and too many outdated scanners, and ‘parts of the NHS are yet to enter the digital era’. The report says the ‘NHS is in the foothills of digital transformation’.
• The NHS’s resilience ‘was at a low ebb’ when it entered the pandemic owing to a ‘decade of austerity’, high bed occupancy rates and fewer doctors, nurses, beds and capital assets than most other high-income health systems.
• The NHS delayed, cancelled or postponed far more routine care during the pandemic than any comparable health system.
• Too many NHS staff are ‘disengaged’ and there are ‘distressingly high-levels of sickness absence’. The pandemic was ‘exhausting’ for many and the result has been a ‘marked reduction in discretionary effort across all staff groups’.
• Regulatory-type organisations now employ some 7,000 staff, or 35 per NHS provider trust, having doubled in size over the past 20 years.
Sir Keir pledges to work on three fundamental areas of reform to make the NHS fit for the future.
He said: ‘This government is working at pace to build a 10-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.’
Report highlights the ‘appaling state of the NHS’
The Health Secretary has also vowed to ‘turn the NHS around’ after the damning report into one of the nation’s most-loved institutions.
Wes Streeting said the review highlights the ‘appalling state’ of the health service in England.
He said the findings will inform a 10-year-plan to ‘radically reform’ the NHS.
NHS England chief executive Amanda Pritchard acknowledged that waiting times across many services are ‘unacceptable’ but said teams were working hard to get services back on track.
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.’
Ms Pritchard said that NHS staff are facing ‘unprecedented challenges’, adding: ‘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.
‘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.’
The report details a number of concerns about various elements of the health service including:
What is the Lord Darzi report and what are the changes?
Lord Darzi, a widely respected surgeon and former health minister, argues in his report that the NHS can be fixed.
He says: ‘Nothing that I have found draws into question the principles of a health service that is taxpayer-funded, free at the point of use, and based on need not ability to pay.’
Lord Darzi says the country ‘cannot afford not to have the NHS, so it is imperative that we turn the situation around’, adding that the health service ‘is in critical condition, but its vital signs are strong’.
He criticises political decision-making under the Conservatives and the coalition government, including the impact of austerity and the reorganisation of the NHS under Andrew Lansley in 2012.
Who is Lord Darzi?
Lord Darzi is an academic surgeon and holds the Paul Hamlyn Chair of Surgery at Imperial College London, specialising in the field of minimally invasive and robot-assisted surgery, having pioneered many new techniques and technologies.
He is co-director of the Institute of Global Health Innovation and the NIHR Imperial Patient Safety Translational Research Centre at Imperial College London.
He has tried to reform the National Health Service (NHS) in England and is recognised internationally as an advocate for applying innovative reforms to health systems globally.
In his report, Lord Darzi says the ‘Health and Social Care Act of 2012 was a calamity without international precedent. It proved disastrous’.
He continues: ‘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.’
As part of his recipe for reform, Lord Darzi says the Government must ‘re-engage staff and re-empower patients’ and must ‘lock in the shift of care closer to home’.
Furthermore, there is a need to drive productivity in hospitals through re-engaging staff, getting people out of hospital when they no longer need to be there and investing in buildings and equipment.
In his speech on Thursday, Sir Keir pointed the finger of blame for the current state of the NHS at the Tories and former Health Secretary Andrew Lansley in particular, saying it is ‘unforgivable’.
Lansley was behind controversial health service reforms in 2012, which the PM said resulted in a ‘calamity without international precedent’ in his speech today.
He said: ‘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.’
Addressing the number of people out of work, Sir Keir will add: ‘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.’
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