Posted on: 13 September 2024
In July 2024, the Secretary of State for Health and Social Care commissioned Lord Darzi to conduct an immediate and independent investigation of the NHS. Lord Darzi has now published his report, which provides an overview of the current performance of the NHS across England and the challenges facing healthcare systems across the country. The review includes particular focus on:
- patient access to healthcare
- the quality of healthcare being provided, and
- the overall performance of the health system
A number of core themes have emerged from the report, which can be summarised as follows:
- Deterioration: The health of the nation has deteriorated over the past 15 years, with a substantial increase in the number of people living with multiple long-term conditions. Nationally, health inequalities are also heading in the wrong direction, and variable care quality and access links to this. There are a number of clear opportunities for ICSs to address the drivers of poor health and inequalities.
- Spending: Too great a share of the NHS budget is being spent in hospitals, too little in the community, and productivity is too low. In addition, too much spending has been delivered with a short-term rationale. Capital investment has been particularly impacted, with around £37bn less invested when compared with similar countries.
- Waiting times: Waiting lists have swelled and waiting times have surged, with queues in our Accident and Emergency departments more than doubling from an average of just under 40 people on a typical evening in April 2009 to over 100 in April 2024. 1 in 10 patients are now waiting for 12 hours or more. Mental health, ADHD and autism waiting lists are also soaring nationally, especially for young people. There has been some success seen in access to NHS Talking Therapies targets.
- Cancer care: The UK has appreciably higher cancer mortality rates than other countries, with no progress whatsoever made in diagnosing cancer at stage one and two between 2013 and 2021.
- Lasting damage: The Health and Social Care Act of 2012 did lasting damage to the management capacity and capability of the NHS. It took 10 years to return to a sensible structure, and the effects continue to be felt to this day.
- Productivity: Too many resources have been poured into hospitals where productivity had substantially fallen, while too little has been spent in the community. A more efficient health system would contribute better to the economy and growth through supporting health and wellbeing, with over half current NHS waiting lists made up of working age adults. This links clearly to the fourth core purpose of ICBs.
Where this report provides an honest assessment on the state of the nation’s health and the health service, it also acknowledges working as integrated care systems to be positive and a significant opportunity. There is no appetite for further structural change. The focus on inequalities and tackling the determinants of health is clear in the report, with an acknowledgement that the current position has been driven by wider factors including a significant reduction in public health funding.
Overcoming the challenges across the country will take time. In West Yorkshire we have already made progress across a number of the themes highlighted in the report, with other transformational programmes and projects in the pipeline. The ways of working that we have built together is important on this journey. Our provider collaboratives are a vehicle to address waiting list issues and to improve productivity and efficiency in flow. Working across the ICB and wider ICS, we will continue to work on solutions across the breadth of pathways our patients and local communities interact with, and working as a health and care partnership, we will maintain our commitment to action on tackling inequalities and the determinants of health.
Over the coming weeks and months, as per all local healthcare systems, we must focus on and continue to do more to improve outcomes and experiences for our local populations, in line with our ten big ambitions.