Experts from the dental profession and wider healthcare discuss the findings of the Lord Darzi report on the issues facing the NHS.
On 12 September, a report on Lord Ara Darzi’s investigation into the state of the NHS concluded it was in ‘critical condition’. The report drew attention to the inaccessibility of NHS dental care, particularly following the COVID-19 pandemic.
It said that ‘there are enough dentists in England, just not enough dentists willing to do enough NHS work, which impacts provision for the poorest in society’.
Commenting on these findings, Lord Darzi said: ‘Although I have worked in the NHS for more than 30 years, I have been shocked by what I have found during this investigation – not just in the health service but in the state of the nation’s health.’
Writing in The Guardian, Lord Darzi also made recommendations to combat the problems highlighted in the report. These include a focus on life expectancy, a cross-society approach mobilising businesses and employers, and investing revenue from health levies into foundational health.
Prime Minister Kier Starmer said: ‘People have every right to be angry. It’s not just because the NHS is so personal to all of us – it’s because some of these failings are life and death.’
He added: ‘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.’
The Prime Minister also pledged a ‘reform or die’ approach to the NHS going forward.
Experts from across healthcare have since shared their thoughts on the report and the government’s reaction to it.
John Makin, head of the Dental Defence Union
We welcome the government’s recognition that healthcare professionals are working in a broken system. Lord Darzi’s report has shone a spotlight on the scale of the challenge the NHS faces. Every day dental professionals go to work to do the best they can for their patients, but the strain staff are under is now clear for all to see.
A survey of our members earlier this year found that only 17% of those responding said they always felt able to deliver optimal patient care. Notably, 41% of respondents said they are planning to reduce their hours because of these pressures. If government does not take this message seriously, the coming years look set to be even more difficult for the NHS.
Lord Darzi’s report challenges the government to take a serious look at where the NHS budget is allocated. Every pound matters. We agree with Lord Darzi that the government must look at the eye watering cost of clinical negligence. In the year 2023/24, clinical negligence payments increased to £2.9 billion, which is approaching 2% of the entire NHS budget. If we are having a serious conversation about NHS finances, figures such as these cannot be ignored any longer.
Tim Mitchell, president of the Royal College of Surgeons of England
In a short space of time, Lord Darzi has articulated what those of us on the frontline see on a daily basis – an NHS unable to provide timely access to care on a routine basis, and a working environment which does not support staff to work at their best.
Having rightly promised to hit the 18-week NHS waiting target within five years the government now needs to get a move on with setting out its plans for meeting this ambition. We need to support existing NHS reforms such as surgical hubs, which are proven to benefit patient care but current waiting times data show these will not be sufficient to generate the necessary step-change in patient care.
There is now a chorus of voices – from the Institute of Fiscal Studies to frontline health staff – calling for greater investment in our buildings as a key part of increasing capacity in the NHS. Investment in staff is necessary and welcome, but chronic underinvestment in our buildings is hindering the ability to deliver more care for patients.
We must not kid ourselves that business as usual or sticking plaster solutions will deliver a substantive change in treatment without proper investment in our NHS, particularly our estates.
Matthew Taylor, chief of the NHS Confederation
This report paints a bleak picture of the state of an NHS which, despite working harder than ever before, has been struggling in the face of rising demand, a decade of underinvestment and the impact of the pandemic. NHS leaders will recognise Lord Darzi’s diagnosis of the NHS’ problems and will work with the government to help address them.
The review has rightly identified many of the root causes, not least how we invest much less in our buildings, technology and equipment than many comparable countries. And how the ill-fated NHS reforms of the early 2010s were an unnecessary distraction and stripped out vital management capacity that has harmed efforts to make services more productive.
We would add the parlous state of social care to that list, which successive governments have failed to address.
‘The task now is to move to identifying the prescription’
The government has taken the first necessary step in diagnosing the problem, and the task now is to move to identifying the prescription. Ministers will need to work on two fronts. First, to help the NHS avoid a winter crisis given the financial crisis that is engulfing the service.
NHS leaders are already having to make tough choices about what services and staff they can afford at a time when they actually want to be preparing to ramp up capacity to meet the usual spike in demand over winter. Emergency funding will be needed in the Autumn Budget, not least to boost staff and capacity in social care.
We also cannot repeat the mistakes of the past by raiding already overstretched capital budgets to plug holes in day to day spending.
In parallel, the government needs to prepare for the long term through its planned 10-year strategy. We know this is far from easy given the perilous state of the public finances.
But the fact remains that unless we restore the NHS to the long term average funding increases it needs, accompanied with changes to the way that local services are delivered, then we will never bring down waiting lists to the levels required as well as preventing more illness from occurring in the first place.
Michael Lavelle-Jones, president of the Royal College of Surgeons of Edinburgh
RCSEd agrees with Lord Darzi’s assertion that the NHS requires a long term funding settlement for health and social care. It is evident that multi-year funding is essential to ensure the NHS can make longer term plans to address the current pressures it is experiencing rather than relying on short term initiatives and funding top ups.
We also agree that the NHS should not be seen as a liability to be managed but as an asset which can have positive economic, as well as health, benefits. Whilst additional money is required, money alone will not be enough and the NHS will require new ways of working in order to provide safe and effective healthcare for the next 70 years.
We look forward to reading Lord Darzi’s detailed funding and reform plan in lead up to the 70th anniversary of the NHS.
Amanda Pritchard, chief executive of NHS England
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.
As Lord Darzi rightly points out, many of the solutions can be found in parts of the NHS today. That is why we are fully committed to working with government to create a 10-year plan for healthcare to ensure the NHS recovers from COVID, strengthens its foundations and continues to reform so it is fit for future generations.
William Pett, head of policy at Healthwatch
People will welcome Lord Darzi’s prognosis on the NHS. Although the NHS does much good, patients repeatedly share their frustrations and confusion about accessing care.
GP access is difficult, NHS dentistry is in disarray, and people face excessive waiting times for hospital treatment. These challenges are not experienced equally, with poorer communities hit hardest.
Restoring public confidence in the NHS and delivering timely, safe and quality care must focus on the issues that matter most to people now and in the future.
We’re calling for improvements to patient communications and administration, giving people a choice of how to access care, a better listening culture within the NHS, and for services to be measured against the quality of patient experiences, not just the length of time they wait for care.
The public will welcome the chance to help shape the future of healthcare and reset the contract between them and the NHS. Especially if it results in clearer rights, more responsive services and an equal say in their care.
Thea Stein, chief executive of Nuffield Trust
Lord Darzi’s damning report underlines the stark realities experienced across almost every corner of the health service. Wide-ranging problems have been growing in plain sight for years and Darzi’s impressively comprehensive assessment will be familiar to anyone who has studied or experienced the slow deterioration of health care provision in England.
While not surprising, the report’s findings are deeply troubling. As our research work has repeatedly shown, too often the NHS is not able to provide people with the timely care they need, despite steadfast public commitment to the core principles of the health service. The impacts of this are not felt equally: people in the poorest areas are particularly struggling to access healthcare.
The big question now is what happens next.
The government has an early opportunity to make good on long-argued points on dysfunctional NHS funding in its first budget next month. The health service is staring down the barrel of a significant shortfall in funding this current year and the Chancellor will need to set out clear plans to tackle this, ahead of a longer-term funding settlement.
Rightly, the report repeatedly references the interrelated, compounding pressures of the desperate state of social care and cuts to public health provision. But by design it does not dig into those issues. In future, we hope to see serious work by the government to address those broader societal issues that determine population health and impact healthcare access.
Ultimately, the Lord Darzi’s diagnostic report sets out important aspirations to be delivered in the forthcoming 10-year plan to treat – and fix – the NHS. But the improvements we all hope for – and that patients desperately need – will take time, commitment and major financial, practical and system-wide support. There will be no quick fixes.
Ronny Cheung, officer for health services at the Royal College of Paediatrics and Child Health
The findings of the Darzi Review confirm the concerns our members have been raising for years – our child health services are in crisis. Despite the best efforts of the child health workforce, chronic underinvestment and a lack of focus on children in health policy, has resulted in children in the UK having some of the worst health outcomes in Europe.
Our children are sicker than before, with rising rates of obesity, asthma, diabetes, worsening mental health and poor oral health. Children are waiting longer than adults to access healthcare, paediatric services have not recovered at the same rate as adult health services, and there is a growing gap between demand and capacity.
Without urgent action, we will have a two-tier health system, where adult services continue to improve but children’s services are left behind.
We once again remind our government that investing in, and reforming paediatric services and workforce is fundamental to the future health and economic wellbeing of our country.
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