Lord Darzi's recently published review has placed a renewed spotlight on long-standing issues plaguing the NHS healthcare system. While the challenges outlined are not new, the review serves as a stark reminder of the urgency required to address them. However, the question now is whether this review will lead to real change or simply be the latest in a long line of reports that failed to motivate reform.

Why the Darzi Review Was Necessary

The Darzi Review comes at a critical juncture for the NHS, with both operational and financial crises escalating. Waiting lists for surgeries and treatments are at record highs, patient satisfaction is plummeting, and healthcare professionals are burnt out. It is a landscape shaped by a decade of austerity, the fallout from the COVID-19 pandemic, and systemic underfunding.

Lord Darzi’s review highlight the following pressing issues:

1. Missed Targets and Poor Patient Outcomes: NHS waiting times for surgeries, cancer treatment, and mental health services have consistently fallen short of their targets for nearly a decade.
2. Staff Burnout: Healthcare professionals, especially nurses and midwives, face mounting pressures, with staff sickness equating to almost one month per year per staff member.
3. Chronic Underinvestment: The NHS has been deprived of essential capital investment, particularly in infrastructure and technological innovations.
4. Increasing Health Inequalities: Deprived communities are hit hardest by declining health services, compounding issues of poverty, mental health, and chronic illness.

With these issues growing steadily worse, Darzi’s comprehensive analysis illustrates why immediate action is essential. The report’s key recommendation—a long-term 10-year NHS strategy—seeks to rebuild the service on a foundation of investment in community care, technology, and operational efficiency.

The Case Against Yet Another NHS Review

Despite the issues highlighted by the Darzi Review, there are valid criticisms surrounding its timing and potential impact. The most prominent criticism is that this report rehashes problems and solutions that have been identified many times before. Over the past decade, numerous reviews and plans for improvement have dissected the NHS’s shortcomings, including the 2019 Long-Term Plan and the Patricia Hewitt Review, yet many of the same issues persist today.

The key difference in the Darzi Review is its urgency in framing these problems not as challenges to be gradually addressed but as existential threats to the NHS’s future viability. However, many stakeholders remain concerned that without political will, this review may suffer the same fate as previous efforts—commissioned, debated, but never implemented.

Learning from Past Mistakes: The Need for Continuity

One of the NHS’s most significant issues is the inconsistency of health policy between successive governments. Reviews like Darzi’s can often feel like isolated exercises, detached from the work and findings of previous administrations. This lack of continuity leads to fragmented strategies that are abandoned or overhauled before they have time to yield results.

For example, the 2019 Long-Term Plan outlined several key areas of focus, including enhancing community-based care and increasing funding for primary care services—goals that are echoed in Darzi’s review. Yet, tangible progress on these fronts remains limited. The lesson here is clear: without a consistent, long-term commitment across governments, no review, no matter how thorough, will deliver the transformational change the NHS needs.

This is why it is crucial for the current government to ensure that Darzi’s findings are not just another fleeting diagnosis but the foundation for a sustainable, cohesive strategy. A 10-year action plan that builds upon past reviews and leverages the expertise embedded in the NHS must be the goal. This plan should focus on clear, actionable targets, including the expansion of community health services, investment in new technology, and a rebalancing of hospital care with preventative health measures.

Without a concerted effort to implement the recommendations this time, the review may become another missed opportunity. The challenge, then, is not just in diagnosing the problems but in ensuring that the solutions are implemented, drawing on both past reports and Darzi’s findings. A critical question that arises is: What happened to the lessons from the last major review, and why are we commissioning new reports instead of building on those insights?

Addressing Interlinked Challenges: The Broader Health Crisis

It is important to acknowledge that the challenges the NHS faces are deeply interconnected. Lord Darzi’s review does touch on the underfunding of public health and social care services, both of which play crucial roles in maintaining the population’s overall health. However, these issues are left largely unexamined, creating a risk that any NHS reform will be undermined if not complemented by broader societal reform.

For instance, the social care system is under immense strain, and without addressing its shortfalls, any improvement in hospital services will be limited. More than 13% of hospital beds are occupied by patients who could be discharged if adequate social care were available. Additionally, public health cuts have exacerbated long-term conditions such as obesity and mental health disorders, further driving the demand for acute NHS services.

Building a 10-Year NHS Plan: Learning from Past Mistakes

The Darzi Review offers a roadmap for a new NHS, highlighting seven themes that should shape a long-term strategy. These include:

• Re-engaging and empowering staff.
• Shifting care closer to home through better community and mental health services.
• Improving productivity in hospitals.
• Investing in digital and technological advancements.
• Enhancing operational management.

These themes resonate with recommendations made in previous reports, but Darzi’s emphasis on staff wellbeing, investment in community care, and the need for smarter operational management feels particularly urgent in 2024.

Underpinning these reforms must be a commitment to restoring NHS funding to historical levels, with long-term investment in infrastructure, new hospitals, and diagnostics. Darzi warns that the NHS faces a £37 billion capital investment gap, with £4.3 billion having been diverted from capital budgets between 2014 and 2019. This shortfall must be urgently addressed if the NHS is to expand its capacity and modernise its infrastructure. Without this, any reforms may collapse under the weight of underinvestment.

The lessons of previous reviews—particularly the need for continuity between government efforts—must not be lost. The incoming government has a rare opportunity to take the findings of both the Darzi Review and past reports to develop a 10-year action plan that can transform the NHS for the future. This should not be another top-down reorganisation but a plan that ensures consistent funding, genuine reforms in community and mental health care, and investment in staff wellbeing and productivity.

The UK government must now act decisively on the review’s recommendations, starting with its Autumn Budget, which presents an opportunity to make a down payment on much-needed reform. The Government must resist the temptation to raid capital budgets to plug short-term funding gaps, a mistake that has been made repeatedly in recent years. Instead, it must commit to the long-term investments necessary to repair crumbling NHS infrastructure, reduce waiting times, and enhance community care.

The Role of Industry and Partnerships in Ensuring NHS Sustainability

As the NHS looks to rebuild, the role of external partners, including industry, will be crucial. The Darzi Review highlights the potential of digital technology, artificial intelligence (AI), and innovations in life sciences to improve healthcare delivery and productivity. Rdealising this potential will require collaboration with industry, which has the expertise and resources to bring about these advancements.

Pharmacy First, cited in the Darzi Review as a success story in Scotland, offers an example of how partnerships with local pharmacy services can reduce pressure on GPs and A&E departments. By continuing to ensure we scale up these initiatives, further resources could be freed up for more complex cases.

Industry partnerships can also help drive the development of new hospitals, cutting-edge diagnostics, and AI tools for healthcare delivery. However, this will require a coherent and well-resourced digital transformation strategy, something the NHS currently lacks.

A key question for the government is: How will it work with industry and other stakeholders to deliver the necessary reforms? The Darzi Review makes clear that fixing the NHS will take more than just political will—it will require the collaboration of NHS leaders, government, industry, and healthcare professionals to ensure that the NHS can sustainably meet the needs of the population.

Looking Ahead: The Role of Policy Connect’s Inquiry into Primary Care

While the Government begins the process of formulating its 10-year NHS strategy, Policy Connect’s Health team have initiated an inquiry into access to primary care services, a key area highlighted by Darzi. The inquiry will explore the barriers that patients face in accessing timely care, including the current state of GP services and the role of commissioning primary care services. It will also examine solutions such as increasing the use of community pharmacy and expanding the role of allied healthcare professionals. These findings will complement the Government’s work in developing its NHS plan, ensuring that patient-centric solutions remain at the forefront of reform.

For further information about this inquiry or to get involved please contact Jasmin Adebisi (jasmin.adebisi [at] policyconnect.org.uk).

Conclusion: Fixing the NHS for the Long Term

As Lord Darzi states, "Fixing the NHS is this country's greatest challenge, and the new Government must make it their top priority." The Darzi Review offers a comprehensive, if damning, assessment of the current state of the NHS, but it also provides a roadmap for reform. However, we have been here before. Successive reviews have failed to drive lasting change because their recommendations were not backed by political will or sustained investment.

The challenge now is to ensure that this time is different. The Government must act on the Darzi Review’s findings, build on the work of past reviews, and develop a cohesive, long-term plan that restores the NHS to its rightful place as a world-class health system. This will require not just investment, but innovation, accountability, and an unwavering focus on patient care. Only then can we begin the long journey to fix the NHS.