NHS in 'critical condition'

The Government has pledged itself to ‘long-term reform’ of the health service, as an independent report declared the NHS to be in ‘critical condition’.

An independent review into the NHS in England by Lord Ara Darzi has presented what the BMA described as an ‘unsurprising’ yet ‘deeply sobering’ assessment of the state of the health service.

Published on 12 September the review’s 163-page report gives a comprehensive breakdown of the critical weaknesses and challenges blighting the NHS, with specific focus on areas concerning patient access, quality of care and overall performance.

The report validates many of the concerns that have previously and consistently been highlighted by organisations such as the BMA, including the ballooning of waiting lists which in June this year saw 300,000 patients having to wait more than a year to access care, compared with just 20,000 in 2010.

The report also paints a damning picture of the state of NHS finances citing how a ‘flat-lining’ in NHS spending during the 2010s led to billions of pounds being diverted from capital budgets to cover day-to-day spending.  

It states that, in doing so, the health service now faces a backlog maintenance bill of £11.6bn and a capital investment shortfall of £37bn.

Lord Darzi’s report further adds that current budgets are also being ineffectively spent, with too little funding being directed into community-based services.

The report also singles out the 2012 Health and Social Care Act, something that Lord Darzi describes as ‘a calamity without international precedent’, warning that this harmful restructuring of the NHS had left a damaging legacy to NHS management structures and systems.

He said: ‘The decade of austerity preceding COVID-19, along with the prolonged capital drought, saw the NHS enter the pandemic with higher bed occupancy rates and fewer doctors, nurses, beds and capital assets than most other high-income health systems. The NHS’s resilience was at a low ebb.

‘It [the NHS] continues to struggle with the aftershocks of the pandemic. Its managerial capacity and capability have been degraded, and the trust and goodwill of many frontline staff has been lost.  

‘The service has been chronically weakened by a lack of capital investment which has lagged other similar countries by tens of billions of pounds. All of this has occurred while the demands placed upon the health service have grown as the nation’s health has deteriorated.’

The BMA was one of many organisations invited to make submissions to Lord Darzi’s review.

Responding to the report, BMA council chair Philip Banfield said that despite the damning nature of its findings, he also felt relief at the fact that the full extent and scale of the problems facing the NHS and its staff had finally been appreciated.

He said: ‘The BMA has tirelessly spoken out about the challenges our health service faces, particularly regarding staff shortages, so one might expect that Lord Darzi's review, which echoes many of the association’s concerns, would be met with a sense of relief—finally, someone understands.

‘While the findings are unsurprising, seeing this report so clearly call attention to just how broken our beloved NHS has become, with the devastating impact on our patients, is deeply sobering. 

‘It’s no secret that the newly elected government inherited an NHS widely wrecked from year upon year of relative underinvestment – especially in general practice. It is imperative that the Health Secretary trusts doctors and experts, fully appreciates the gravity of the situation, and takes action swiftly.’  

Following the publication of Lord Darzi’s report, prime minister Keir Starmer described the NHS as ‘broken but not beaten’ and vowed he would take the necessary steps to implement the changes and reform needed to build a health service ‘fit for the future’.

In a speech given on 12 September he said that while his government would always make the investments in our NHS that are needed ‘reform does not mean just putting more money in’.   

The Government is expected to use the report to inform a proposed ’10-year-plan’ for the NHS in England, something that Sir Keir said would centre around three major themes including increasing digitisation of the NHS, shifting care from secondary settings to the community and pursuing a preventative rather than reactive approach to the nation’s health.

Speaking ahead of the Prime Minister’s announcement, Prof Banfield welcomed ministers’ pledge for radical reform, but added that honesty with doctors, healthcare staff and patients was also crucial to finding a way forward.

He said: ‘The Government is right to call the needed reform "radical".  Without radical action, the NHS won’t survive. As pointed out by Lord Darzi, ‘we cannot afford not to have the NHS’.”

‘Engaging with doctors is essential, valuing the staff tasked with resuscitating the NHS is critical, but an honest conversation with the public about what money goes where, what will and will not be provided, and what will be rationed until additional resources are made available, is imperative.’