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England’s NHS is in “critical condition” after years of underfunding, an official review into the health service has warned.
Lord Ara Darzi’s government-commissioned report, out on Thursday, attributed the dire state of the health system in large part to the austerity policies of the 2010s, which slashed public spending in a bid to cut the budget deficit.
In a speech on Thursday morning addressing these long-awaited findings, Prime Minister Sir Keir Starmer will pledge to carry out the “biggest reimagining of our NHS since its birth”. He will say: “We know working people can’t afford to pay more, so it’s reform or die.”
The 142-page Darzi review could help to manage expectations of how quickly the service can be improved while building support for the new Labour government’s plans for reform.
The findings could also lay the foundations for passing the blame for the state of the NHS on to the previous Conservative administration ahead of what is expected to be a challenging winter.
“The NHS is now an open book,” concluded Darzi, a former health minister and renowned surgeon who carried out a previous review of the NHS in 2008. “The issues are laid bare for all to see.”
England has spent almost £37bn less than peer countries on its health assets and infrastructure since the 2010s, the review found. And under-investment has forced the NHS to raid capital budgets in order to manage day-to-day spending.
A lack of resilience within the service meant the Covid-19 pandemic had left it with higher bed occupancy rates and fewer medical staff than most other high-income health systems, Darzi said.
Less well known, he added, was that the NHS had been forced to cancel or postpone “far more routine care during the pandemic than any comparable health system”.
Between 2019 and 2020, the number of knee replacements, for example, fell by 68 per cent compared to an average decline among OECD nations of 30 per cent. Discharges from hospitals across the board dropped by 18 per cent over the same period — representing the biggest decline among comparable countries.
Darzi said there was evidence that in the years since the pandemic NHS staff had become “disengaged” and there were “distressingly high-levels” of absence for sickness. This amounted to as much as one working month a year for each nurse and each midwife.
The report called for a larger proportion of the NHS budget to be allocated towards primary care in the community.
Despite successive government pledges to rebalance funding to meet just such an aim, the share of the NHS’s finances spent on hospitals between 2006 and 2022 increased from 47 per cent to 58 per cent, he noted.
“Too many people are ending up in hospital, because too little is spent in the community,” he said. More than 1mn people were waiting for community services in June this year.
Someone arriving for treatment in an accident and emergency unit in 2009 would have found on average just under 40 people ahead of them in the queue — by 2024 that number had risen to 100, the report found.
Pointing to long waits in A&E, Darzi cited research from the Royal College of Emergency Medicine that showed that such delays may have resulted in as many as “268 additional deaths per week in 2023, or nearly 14,000 over the year as a whole”.
Experts have said strengthening services such as GP surgeries and dentistry would help to alleviate pressure on struggling hospitals and A&E departments through earlier diagnosis and treatment.
The report noted that England had almost 16 per cent fewer fully-qualified GPs than other high-income countries relative to population size.
And the health of the population had “deteriorated”, with more people living with conditions for longer, increasing pressure on the NHS and affecting performance.
It also blamed efficiency problems in the NHS on the upheaval caused by a big round of Tory health reforms under the 2012 Health and Social Care Act, which saw changes in management structures. He described the reforms as a “calamity without international precedent”.
Darzi said that despite having worked across the NHS for over 30 years, he had been “shocked” by what he uncovered during his investigation, “not just in the health service but in the state of the nation’s health”.
Setting out the government’s top three priorities for reform, Starmer will vow to move the NHS away “from an analogue to a digital” service, shift more care from hospitals to communities and “be much bolder in moving from sickness to prevention”.
Amanda Pritchard, NHS England chief executive, said the service was committed to working with the government to create a 10-year plan for healthcare to ensure the service “recovers from Covid, strengthens its foundations and continues to reform so it is fit for future generations”.