Three reports lay bare scale of NHS malaise. But will Rachel Reeves fund a transformation? | James Tapper and Toby Helm

The diagnosis has been swift. Lord Darzi has taken just nine weeks to deliver his report on the state of the NHS. The treatment is likely to take far longer and be more painful.

Wes Streeting’s first major act as health secretary was to appoint the eminent surgeon, nicknamed Robo Doc for his use of robots in operations, to reveal “hard truths” about the NHS in England. What Darzi concludes is expected by many to form the foundation of Labour’s plans for treating a population that is getting older and sicker – without bankrupting the nation.

Existing NHS plans were drawn up under Theresa May’s government and published before Covid magnified its problems. Waiting lists were growing before March 2020, but ballooned to nearly 8m after the pandemic hit, hospitals are crumbling , and long-term sickness has soared, with 2.8 million people out of the workforce, 900,000 more than in 2019.

But perhaps the biggest challenge is that there are now 11 million over‑65s in the UK, up from 9.2 million in 2011, and older people are more likely to need care. A report today from consultancy Carnall Farrar (CF), warns that if demand continues to grow at its current rate, by 2029 the NHS will need to do 50% more work than it does now.

Even if Labour meets its pledge to deliver another 40,000 appointments a week, it will not be enough to stop waiting lists lengthening.

“The NHS needs reform, not just ever more activity,” said NHS Confederation chief executive Matthew Taylor. “This means shifting to earlier, more preventative services – including primary and community care – to slow the rise in demand. It will also mean boosting productivity through modern technology and buildings and equipment fit for the 21st century.”

There are real deep-seated worries about NHS funding, but the right support and leadership can make a difference

Sir Julian Hartley, NHS Providers

But doing that means spending money. A survey by NHS Providers, which represents hospital leaders, finds that 44% believe they do not have enough money to run their current services. Some are reducing staff and are “even having to consider scaling back services”.

Sir Julian Hartley, chief executive of NHS Providers, said: “This survey sets out the daunting financial pressure facing the NHS right now. Trust leaders are facing some really difficult decisions.”

Trusts are trying to get staff to work longer by paying time-and-a-half for weekend and evening shifts, and leaders hope digital tools such as the controversial Federated Data Platform which shares patient information, will help. But that “can only go so far without significant strategic investment in infrastructure and digital technologies,” Hartley said.

“There are real deep-seated worries about NHS funding and how those pressures are intensifying. It’s never been tougher. But they’re also showing how the right support and leadership can make a difference.”

Rachel Reeves may take some convincing to find extra cash to fund an NHS transformation. There will be collective crossed fingers this week that she and Keir Starmer are persuaded by Darzi’s report.