Lord Darzi Report: Fixing the NHS Once and For All
- Lord Darzi’s independent review concludes that the NHS is in “critical condition, but its vital signs are strong.”
- He urges the NHS to invest in community and primary care, better utilise patient data, improve the NHS App, and leverage AI and technology to streamline care delivery.
- Prime Minister Sir Keir Starmer responded to the report by pledging a systemic 10-year reformation plan to address the challenges.
Following the June election, an independent review of the NHS was commissioned by the Labour Government and led by the party’s former health minister, Lord Ara Darzi. More than 500 pages of evidence were examined by the independent peer over the last two months, with his findings published by the Department of Health and Social Care on September 12.
The 160-page report concluded that the NHS is in “serious trouble” financially and operationally and how it has failed to deliver on key obligations to the public since 2015, such as tackling health inequalities, record-long waiting times, workforce pressures and budget deficits.
As a result, millions have been deprived of access to quality care and patient satisfaction is at an all-time low. The report also highlighted how the UK health sector has continuously lagged behind other countries in several key areas, including digital transformation, capital investment, workforce capacity and pandemic response.
Lord Darzi report summary: What it means for:
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Digital
The Darzi report highlights a missed opportunity for the NHS to embrace digital healthcare over the past decade, with significant consequences for its poor performance. Despite radical digital transformations in other sectors, the NHS remains in the “foothills” of this shift.
Crumbling infrastructure, outdated technology, and a lack of investment in modern tools like automation and digital systems have hindered its ability to adopt a “predict and prevent” model of care. Lord Darzi emphasises that this digital lag has directly impacted the NHS’s capacity to manage the pandemic and subsequent care backlog.
Despite nearly 80% of adults registered with the NHS app, only 20% are reported to use it each month, with Lord Darzi noting how the app is failing to deliver on efficiency and provide the ‘digital-first’ experience that patients expect.
With productivity levels at least 11.4% lower compared to what they were in 2019, he also states that a major “tilt towards technology” is crucial to improving the staff and patient experience, reducing waiting times, and helping us move forward, particularly in areas outside hospitals where digital systems and AI can be utilised.
- The Workforce
Lord Darzi notes that the NHS has majorly lacked in investment opportunities where primary and community services are concerned. The report highlights how community nursing numbers have dropped by 5% from 2009 to 2023 while the number of nurses working with adults in hospitals has increased by 35% and 75% in nurses working in hospitals with children in the same time period.
‘Since at least 2006, and arguably for much longer, successive governments have promised to shift care away from hospitals and into the community,’ said Lord Darzi. The Royal College of Nursing (RCN) predict that nursing numbers will more than half by 2029 and has called upon Labour to prioritise investments in district nursing professions as these people play an integral role in keeping people well within the community and preventing hospital admissions.
The RCN has also called upon the government to scrap loans for those working in public services, boost recruitment through state-funded degrees, and improve pay to both attract and retain staff.
- Funding and Resource
Since 2010, the NHS has faced a £37 billion funding gap spurred by ongoing confusion from top-down organisations, austerity, and the effects of the pandemic according to a report commissioned by Health Secretary Wes Streeting. The report noted that 40 new hospitals could be built with these funds, with more than enough left over to rebuild or refurbish every GP practice in the UK.
Chronic underfunding has also jeopardised primary care services, with the sector receiving “a 30% cut in real terms over the last seven years and a fall in share of the NHS budget from 2.4% to 1.6%.” The UK’s network of pharmacies has been hit particularly hard by this cut, with 1,200 community pharmacy closures in 2017.
- ICBs
The report highlights the importance of Integrated Care Boards (ICBs) in the future structure of the NHS but identifies challenges in how they currently function. While the Health and Care Act of 2022 aimed to strengthen ICBs by promoting integrated healthcare with local government, the third sector, and NHS organisations, inconsistencies remain in their roles, particularly around performance management and population health strategies.
When referring to the 2023 Hewitt Review, Lord Darzi also concluded that “The function and authority of ICBs remains unclear in some important respects” and that “ambiguity persists” in the relationship between ICBs and providers.
The report calls for clearer definitions and clarity of responsibilities to ensure ICBs can effectively address health inequalities locally and nationally. Lord Darzi also advocates for a shift from competition to collaboration, moving away from outdated financial incentives towards a framework focused on community health.
- Social Care
With 13% of hospital beds occupied by people waiting for social care support, Lord Darzi refers to the state of the social care sector as “dire”. He describes it as under-resourced and under-valued, with a growing yearly gap between “those in need and those receiving publicly funded care.”
Labour promised to focus on the social care workforce when it won the electoral vote in July. In addition to a Fair Pay Agreement that would set the minimum wage to £12 per hour for those working in adult social care, the government said it would address growing inequalities within the social care system, cap care costs, and push for greater integration between the NHS and social care services.
When reporters asked the Prime Minister about his plans to reform social care and whether these targets still applied, he repeated Labour’s ambition to bring in a National Care Service. He said that the previous government had made the same promises but these were “delayed because they were undeliverable.” Sir Keir Starmer said that Labour will take the time to review the social care policy so that this time it “gets done properly.”
The UK Government’s Response
In response to the Darzi report, Kier Starmer announced that the UK government will aim to publish a 10-year major reform plan in Spring 2025. The plan will focus on driving significant structural change in the health and social care sector, ranging from moving care from hospitals into the community and increasing funding for these services, transitioning to a digital NHS, and focusing heavily on prevention as opposed to simply “treating” illness.
Access Customer and Partner Responses
Peter Saunders, Head of NHS Financial Advisory, Grant Thornton UK LLP, says:
“As we have previously called for, the NHS needs to be supported in moving away from short-termism and towards longer term planning and funding settlements that provide certainty, if it is going to be able to effectively address the challenges presented.
As emphasised by Darzi, and the initial government response, the remedies and fixes are not quick, and we are unlikely to see notable improvements in the short or even medium term. But it’s crucial that this does not deter action and that steps are taken now if we hope to revive our critical national health service.”
Adam Crampsie, CEO at Everyturn, says:
“While reforms are discussed to improve people’s experiences of the NHS, we would urge focus and investment in community-based social care services, to tackle the issues that are pushing people into mental and physical ill-health. Far too many people are forced to stay in hospital for longer than is healthy for them, because there is no suitable care when they leave.
“Services like ours help people to get back on their feet, become connected to their communities, and find work or activities that are satisfying and meaningful. This creates good health, lasting change, and transforms communities.
“Well-funded, person-centred social care can and must be part of the planning to make the NHS fit for the future.”
Manager at Bearing Point, Lexi Lavelle says:
“Driving integrated care through technology will be critical to realising the ambition of the Darzi report and the Government response. There is a real challenge in joining up the huge number of health and social care providers, creating wider access and use of person-centred data to break down cross-organisational barriers. It’s about considering the whole person, and we need digital solutions, implemented and adopted, to facilitate this. It is necessary to both improve patient experience and reduce inefficiencies.”
The Access Group’s Response
The NHS may be fragile, but it is fundamentally strong thanks to its core values, dedicated staff, and universal care principles. Nevertheless, without reform, it risks remaining stuck financially, falling behind with technological advancements and is unlikely to meet the growing demands of the population. Such outcomes pose significant threats to future generations and could compromise their accessibility to quality care.
While no single solution can address all the challenges the NHS faces, we at Access believe that a strategic, person-centred, technology-driven approach firmly rooted in integration is key to reducing inefficiencies and improving outcomes for all.
We’re working with our partners to achieve this by producing smart solutions that not only bring existing systems together to streamline processes and reduce operational friction, but we’re also developing technology to support the person-centred approach across the entire continuum of care.
Access’ Managing Director of Health, Support and Care, Steve Sawyer, backs the Darzi report and the health sector’s integration efforts with the following statement:
“With the Autumn Budget imminent, the hope is that the much-needed change and investment signalled by Lord Darzi will be recognised in the coming weeks. This will make significant inroads in addressing the overall success of the integrated care agenda. With the strong emphasis on technology as a driver for change, the review signals a positive evolution in scaling interoperable digital tools that tackle patient flow and help prevent people from entering acute settings."
