Darzi review says the NHS is in a critical condition but sets out a treatment plan

Even factoring in the many manifestations over recent years of the NHS’s deep crisis, some of Lord Ara Darzi’s findings in his verdict on the state of the service are arresting. A&E is in such “an awful state” that thousands of people die every year because they aren’t seen there fast enough.

“Starving” the service of vital capital funding has left “crumbling buildings, mental health patients being accommodated in Victorian-era cells infested with vermin with 17 men sharing two showers, and parts of the NHS operating in decrepit portable buildings”. Efforts to improve early diagnosis of cancer saw “no progress whatsoever made … between 2013 and 2021”, despite many lives depending on that.

But Darzi’s report is more than just another litany of NHS gloom. Like any good doctor, he has not just diagnosed what ails the patient but also set out his treatment plan to restore good health. Despite concluding that the NHS “is in critical condition”, he adds, reassuringly, “its vital signs are strong”. To prove his case, he cites the service’s “extraordinary depth of clinical talent”, staff’s “shared passion and determination to make the NHS better for our patients” and the fact that “the NHS has more resources than ever before”.

On waiting times, he is quite hopeful that things will – eventually – get better. The ex-health minister (2007-10) is one of a number of veterans from the Blair/Brown years who helped rescue the NHS from its enfeebled state after years of Conservative stewardship and are now helping Keir Starmer and Wes Streeting try to repeat the trick. These include Alan Milburn, who is now advising Streeting and Paul Corrigan, another adviser who is now drawing up Labour’s promised 10-year NHS plan. As such, his assertion that “just as we in the NHS have turned around performance before, we can do it again” is a determined voice of experience, not bluster.

Streeting asked the cancer surgeon to make his report a roadmap for the 10-year plan, which is expected next spring. It includes the advice that, with so many staff now feeling so “disengaged” after Covid, the NHS workforce must be re-engaged and re-energised. That is vital for its own sake but also because without happier staff the NHS will not be able to solve its productivity puzzle, which is that, despite record staff numbers and its biggest ever budget, its productivity has fallen. Improved pay should help but better working conditions are needed too.

Darzi’s terms of references did not allow him to recommend a bigger budget or specify exactly how much more money may be required in the years ahead to help the NHS get back on its feet. But his report is clear that the NHS needs much more capital funding, to buy new scanners and replace some of the many dilapidated, sometimes dangerously archaic, facilities in which it provides care. Others, such as the NHS Confederation, have called for a £7bn rise in capital spending. Will it be available?

Money is the elephant in the room of Darzi’s impressive document. For example, creating “a neighbourhood NHS”, by shifting care from hospitals into the community, will inevitably require more money, not least to cover the cost – albeit temporary – of what health geeks call the “double running” of old and new services until the latter are established. Will it be available?

With the new government contending with the poisoned financial legacy left by its predecessor, an NHS which became Labour’s most potent illustration of the Tories’ “broken Britain” now looms as not just its most pressing problem to fix but also its most expensive.