By Andy Yorke
Lord Darzi’s 12 September report on NHS England has been widely welcomed for its defence of the beloved health service. One of the first acts of the new Labour government was to commission the esteemed academic surgeon to carry out ‘a rapid investigation of the state of the NHS, assessing patient access, quality of care and the overall performance of the health system’. After a searing indictment of Tory austerity, Darzi provides a robust defence the NHS ‘Our staff in roles at every level are bound by a deep and abiding belief in NHS values and there is a shared passion and determination to make the NHS better for our patients’, but despite this the report itself is double-edged.
It ignores the deep damage of privatisation while pushing for an expansion of technology and community health provision that will hugely accelerate it – not a surprise as he put forward the same arguments in his 2008 report for the Blair-Brown government, bitterly denouncing the Tories for “a lost decade” of progress, instead bringing the NHS to its knees with austerity and clumsy reorganisations.
Darzi’s findings chime with the claims of Health Secretary Wes Streeting that the NHS needs “three big shifts” – a digital revolution, a shift from hospitals to preventative medicine and a from hospitals to community care. The Prime Minister’s immediate reaction to the report was to state that ‘This isn’t just going to be solved by more money, it’s solved by reform.’ A new ten year plan, scheduled for next year, promises, or more likely threatens the ‘biggest reimagining’ i.e. restructuring of the NHS in its history.
Tory austerity: “The most austere decade since the NHS was founded”
Darzi’s report brings together the different facets of the healthcare crisis and above all blames the austerity of the 2010s, when spending grew no more than 1% a year and chaotic Tory “reorganisations” opened the NHS further to the private sector. As a result, the NHS has been “broken” by a lack of investment in staff and crumbling buildings, leaving a 100,000 staff vacancies and hospitals with wings from the Victorian era, vermin infestations and ‘decrepit portacabins’.
Covid hit Britain even harder than other wealthy countries, as the ‘NHS delayed, cancelled or postponed far more routine care during the pandemic than any comparable health system’ with waiting lists times spiking resulting in14,000 extra deaths a year from A&E waiting times alone. Even more die waiting for hospital procedures, the 20,000 patients waiting over a year in 2010 had risen to 300,000 by 2024, after the worst spikes in waiting times after Covid had fallen.
He also notes that levels of health in the population have deteriorated since 2010, another result of austerity. By 2024 a million people were on waiting lists for mental health services, 345,000 of them for over a year and a tenth children or under the age of 18. Of the 2.8 million on long term sick in Britain, almost a third are suffering with mental illness. After years of Tory cuts, the number of mental health nurses has just returned to its 2010 level, but with a much bigger workload.
Darzi says there can be no doubt that the NHS is ‘in serious trouble’ while public satisfaction is at record lows. The result to warm the cockles of every Tory grandee’s heart, is that there are now 6.4 million patients on waiting lists resulting in a mass turn to private healthcare providers. With insurance funded admissions to private hospitals hitting a record high of 238,000 in the first three months of 2024.
Before the election Streeting stated that more years of the Tories would mean the NHS becoming ‘a poor service for poor people and everyone else going private’. While the Tories’ crude policies to push private businesses at the direct expense of the NHS, have seen it meltdown taking some of their vote with it, will Labour’s budgets substantially fill in the £21 billion black hole in NHS funding?
While the Tories were forced into a partial retreat on the NHS, restoring funding due to public outcry around wait times, it was too little too late and a drop in the ocean compared to what it really needs, a miserly 3% per year, allowing no extra spending on staff or buildings.
For Labour, solving the NHS crisis means not just avoiding toxic issues which helped poison the Tory election campaign, but also offsetting the bad publicity about austerity and winter fuel benefit cuts, shoring up illusions that Labour will save the “jewel in the crown” of the much-reduced postwar welfare state.
While Darzi’s report recognises that the late Tory turn to increased spending and staffing since Covid have not been met by an equal lowering of waiting lists, his highlighting of their ‘productivity’ as a central concern is a concession to Tory arguments. He also accepts the Tory 2022 plan reorganising the NHS into 42 Integrated Care Boards that ‘integrate’ the third sector and business directly into area planning and provision of healthcare ‘services’. He is silent on the drive for privatisation under the New Labour government that the Tories have built on.
Labour threatens the NHS
Under Labour’s plans, there will be even more avenues to build the new private health companies of tomorrow. Streeting commissioned Darzi’s report as a means of ‘diagnosing the problem’, and now he will ‘write the prescription’. It remains to be seen if there is a difference of opinion on the direction of the NHS. Darzi underlined not only free healthcare but also explicitly attacked mixed health systems:
“With the prominent exception of the United States, every advanced country has universal health coverage – and the rest of the world are striving towards it. But other health system models – those where user charges, social or private insurance play a bigger role – are more expensive, even if their funding tends to be more stable. It is not a question, therefore, of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around.”
The Government appears to be taking little to no notice of these findings. As part of his aggressive support for Israel, Wes Streeting took a paid-for tour of its health system to look at how it uses tech start-ups, saying it is ‘ten years’ ahead of Britain. Israel has a national health service that is precisely a basic service that only the poor fully rely on, while supplementary and private health plans are purchased by the majority of the population.
More money for the NHS means more falling into the hands of private capital, which will not improve these issues. A 2019 British Medical Association study found that two-thirds of doctors working in community care, general and acute services, and mental health felt that ‘independent sector provision has had a negative impact on quality of services provision in those areas.’
Unions and NHS groups must conduct a people’s audit into the NHS and develop a plan for its restoration.We need to organise to defend our hospitals and integrate them into a community healthcare system, while prioritising filling the huge labour shortage.
We must increase pay, provide services with adequate funding, bring back free bursaries and centralise GP surgeries as NHS run services.
