The Prime Minister has pledged the ‘biggest reimagining of our NHS since its birth’ following the publication of the Darzi review.
Sir Keir Starmer outlined three ‘fundamental’ areas of reform, including ‘shifting more care from hospitals to communities’, but said that reform ‘does not mean just putting more money in’.
It follows yesterday’s publication of a review into the state of the NHS led by Lord Ara Darzi, a cancer surgeon and former Labour minister, which found that the health service is in a ‘critical condition’ but can be saved, with increased general practice funding.
In a speech at the King’s Fund conference today, the Prime Minister said: ‘Reform does not mean just putting more money in.
‘Now, of course, even in difficult financial circumstances, a Labour government will always make the investment in our NHS that is needed, always, but we have to fix the plumbing before turning on the taps.
‘So hear me when I say this: no more money without reform.’
He added: ‘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.
‘Only fundamental reform and a plan for the long term can turn around the NHS and build a healthy society. It won’t be easy or quick. But I know we can do it.’
The Prime Minister also mentioned the long term effects of the 2012 Health and Social Care Act, which is described in the Darzi report as ‘a calamity without international precedent’ which ‘proved disastrous’, as well as the consequences of underinvestment throughout the 2010s.
He said: ‘Lord Darzi describes [the 2010s] as “the most austere decade since the NHS was founded”. Crumbling buildings, decrepit portacabins, mental health patients accommodated in Victorian-era cells infested with vermin.
‘The 2010s were a lost decade for our NHS… which left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow.’
What was in the Darzi report?
Lord Darzi was commissioned by health secretary Wes Streeting to undertake ‘a rapid investigation of the state of the NHS, assessing patient access, quality of care and the overall performance of the health system’.
The report, released yesterday, noted that ‘spending in primary and community settings had a superior return on investment when compared with acute hospital services’ and it ‘therefore makes sense that this should be the fundamental strategic shift that the NHS aspires to make’.
The NHS has been ‘chronically weakened’ by a lack of capital investment which has lagged other similar countries ‘by tens of billions of pounds’, while the demands placed upon the NHS ‘have grown’, it added.
And GPs are ‘expected’ to manage and coordinate ‘increasingly complex care’, but do not have the resources, infrastructure and authority that this requires, the report said.
Meanwhile, there is an overall NHS shortfall of £37bn of capital investment which ‘could have rebuilt or refurbished every GP practice in the country’.
It said: ‘These missing billions are what would have been invested if the NHS had matched peer countries’ levels of capital investment in the 2010s.
‘That sum could have prevented the backlog maintenance, modernised technology and equipment, and paid for the 40 new hospitals that were promised but which have yet to materialise. It could have rebuilt or refurbished every GP practice in the country.’
The report argued that ‘care should be delivered in the community’, closer to where people live and work, and that hospitals ‘should be reserved for specialist care’.
It said that there must be ‘a shift’ in the distribution of resources towards community-based primary care services.
It added: ‘It builds on the fact that general practice is how most people commonly interact with the health service and GPs’ expertise as generalists.
‘Indeed, research by the NHS Confederation has demonstrated that spending in primary and community settings had a superior return on investment when compared with acute hospital services.
‘It therefore makes sense that this should be the fundamental strategic shift that the NHS aspires to make.’
But Lord Darzi said that in order for this to happen, this change in financial flows must be locked in by the Government.
The report said: ‘Lock in the shift of care closer to home by hardwiring financial flows. General practice, mental health and community services will need to expand and adapt to the needs of those with long-term conditions whose prevalence is growing rapidly as the population age. Financial flows must lock-in this change irreversibly or it will not happen.’
Lord Darzi also highlighted that with primary care doing more work for a lesser share of the NHS budget, he heard ‘significant irritation felt by GPs’ who perceive that ‘more and more tasks are being shifted from secondary care back to primary care’, with a ‘never-ending flow’ of letters demanding follow-ups and further investigations.
‘This frustration is understandable when the hospital workforce appears to have expanded to the amongst the highest levels in the world,’ he added.
He also said that GP practices have ‘the best financial discipline in the health service family’ as they cannot run up large deficits in the belief that they will be bailed out.
But that despite rising productivity, an expanding role, and ‘evident’ capacity constraints, the relative share of NHS expenditure towards primary care fell by a quarter in just over a decade, from 24% in 2009 to just 18% by 2021, continuing a downward trajectory from their peak in 2004
The problem is that to provide high-quality, multidisciplinary care in the community requires resources ‘that often are not there’, the report said.
It pointed out that 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’.
‘We have underinvested in the community,’ Lord Darzi added. ‘We have almost 16% fewer fully qualified GPs than other high income countries relative to our population.’
The report also found that:
- The current GP standard contracts are complex and can mean ‘that doing the right thing for patients can require doing the wrong thing for GP income,’ which can’t ‘be right’.
- The primary care estate is ‘plainly not fit for purpose’ as 20% of the GP estate predates the founding of the health service in 1948. Some practices face ‘unreasonably high charges’, while others have too little control over their space due to how PFI-type schemes they are part of are run. The report said it’s ‘just as urgent to reform the capital framework for primary care as for the rest of the NHS.’
- The CQC is ‘not fit for purpose’. Many clinicians and managers believe the CQC to be ‘excessively focused on staff numbers and paperwork, at the expense of patient experiences and clinical outcomes’, the investigation found.
Lord Darzi concluded that there is a need ‘to rebalance the system’ towards care in the community rather than ‘adding more and more staff to hospitals’.
And he said that the NHS is ‘in critical condition’ but ‘its vital signs remain strong’.
But the system and its staff ‘have turned things around before’, and he is confident this will happen again.
‘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.
‘It took more than a decade for the NHS to fall into disrepair so it’s going to take time to fix it. But we in the NHS have turned things around before, and I’m confident we will do it again.’
NHS England has pledged ‘to work closely with the government’ on its mission to rebuild the NHS.
NHS England chief executive Amanda Pritchard said: ‘As this report sets out, staff are the beating heart of the NHS with a shared passion and determination for making the NHS better for patients – but it is also clear they are facing unprecedented challenges.
‘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.’
A version of this story was first published by our sister title Pulse
