Fixing the NHS is the challenge... not identifying what is wrong

Lord Darzi's report on the state of the National Health Service in England is here!

Across more than 150 pages, NHS surgeon and independent peer Lord Darzi sets out in clear, painstaking detail the failings of the NHS in England but identifying what is wrong is the easy bit – fixing it is an altogether different challenge.

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Key Points:

• The National Health Service is in serious trouble alongside the deteriorating health concerns of the public that impacts its performance.
• Public satisfaction with the NHS is at its lowest ever.
• Life expectancy increased in the 2000s, plateaued in the 2010s, and decreased during the Covid-19 pandemic1.
• There are significant health inequalities
• Waiting times for various services, including mental health and community services, are excessively long.
• People are struggling to see their GP
• The performance of A&E departments has significantly declined, with long waits becoming normal. The report states 'A&E is in an awful state'
• There are delays in cancer and cardiac services, with targets not being met.
• Hospital productivity has fallen
• Waiting times for hospital procedures have ballooned
• There has been underinvestment in community services, leading to increased pressure on hospitals.
• The NHS budget is not being spent where it should be
• NHS staff are disengaged, with high levels of sickness absence and reduced discretionary effort.
• Facilitates and equipment is outdated
• The patient voice is not loud enough

What does it say about social care?

Here are the key points about social care from the document:

• The dire state of social care means 13% of NHS beds are occupied by people waiting for social care support or care in more appropriate settings.
• Social care is a vital service in its own right
• Social care has not been valued or resourced sufficiently, which has both a profound human cost and economic consequences.
• Publicly funded social care is provided for fewer and fewer people while the demand for it has risen

It is important to remember that the scope of this investigation was the NHS and not social care, but the message is clear: without addressing social care and successfully shifting care closer to home, the NHS will continue to struggle.

What are the recommendations

There are some important themes that have emerged for how to repair the NHS, which will need to be considered alongside strategies to improve the nation’s health and reforms to social care. A 10-year health plan is going to be devised, however Lord Darzi has recommended it includes:

• The NHS's core principles remain - taxpayer-funded, free at the point of use, based on need not ability to pay.
• Re-engage staff.
• Re-empower patients.
• Lock in the shift of care closer to home by expanding general practice, mental health and community services.
• Simplify and innovate care delivery for a neighbourhood NHS. Embrace multidisciplinary models of care that bring together primary, community and mental health services.
• Drive productivity in hospitals to bring down waiting lists through technology and AI, improve equipment and investment in facilitates.
• Reform to make the structure deliver.

My Thoughts

Reading through the report, i found myself thinking this is nothing new or that the public have been saying this for years. You find it hard these days to find someone who talks positively about their experiences with the NHS which is sad. Even myself as someone who has always defended the service has found myself more critical having had to use it over the last year with lost records, long wait times, duplication and to be honest a poor service which left me in no better place and having to go down the private route.

Working closely with NHS colleagues over the years, it is apparent that there is too many layers of management. The report states that a reorganisation of NHS England and integrated care boards is necessary nor desirable, however I think this is essential.

The report highlights issues like health inequalities, underinvestment in community services, and outdated facilities and touches on social care, but it is so much more. There should be more focus on these things:

• Better working conditions - not just facilities, but rest areas, the provision to access a hot meal and drinks during every shift, appropriate numbers of staff working to prevent staff from being stretched too thinly,
• Increase the wellbeing offering
• Pledge to resolve disputes such as pay awards as soon as possible, for the sake of those who rely on and work in the NHS
• Review all suppliers to ensure better value for money
• Strip out the excessive management levels
• Long service recognition
• Implement technology and AI
• Be adventurous and try a new model and way of working

Improving the NHS will take time - like Darzi has said "It has taken more than a decade for the NHS to fall into disrepair so improving it will take time."

Further reading

• You can read the summary letter here
• You can read the full report here

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