The NHS is in “serious trouble” unless major reforms are made, according to the by renowned surgeon and former Labour Health minister, Lord Ara Darzi.
Author
Judith Smith
Professor of Health Policy and Management, University of Birmingham
This independent investigation into the health service in England highlights the many problems facing the NHS – including shocking waiting times for appointments and treatments, the , and a failure over many years to invest sufficiently in the latest information, diagnostic and medical technologies.
Darzi’s report also underscores the many reasons for the NHS’s current problems – citing factors such as public sector , the , the COVID-19 pandemic, cuts to public health budgets, and a failure to reform social care.
Following the review, Prime Minister Keir Starmer said in a speech that the NHS was – but there wouldn’t be additional funding without reform. Starmer also highlighted three fundamental NHS reforms the government will focus on making first, based on Darzi’s recommendations.
Designing and implementing these reforms will be a monumental challenge for the government. But if implemented successfully, they could start to transform the NHS.
Moving from analogue to digital
The NHS has struggled for years to become fully IT-enabled.
For example, while GP practices all use electronic records systems and often have app- or web-enabled service access, they don’t with other healthcare providers. And, despite most hospitals having electronic records, they’re not always used to full effect. This is particularly true for across different NHS organisations.
Darzi describes the NHS as being “in the foothills of digital transformation” – noting that IT innovations too often add to, rather than reduce, staff workloads. But when properly implemented, digital technologies could improve productivity and streamline care.
After a for NHS IT under the Blair government, there may be apprehension about how to proceed. A good place to start would be improving basic patient administrative processes.
This is a of – and would significantly improve patients’ experiences of the NHS. For instance, patients would spend less time recounting symptoms to different professionals and could avoid unnecessary consultations.
Although technology is a key part of enabling more modern, patient-focused care, its implementation will need and evaluation to ensure these potential benefits are realised.
Shifting to community and primary care
Reallocating funding from hospitals to has been a long-term ambition for NHS policymakers. This is based on that shows most people prefer to receive care close to home provided by local doctors, nurses and care workers – avoiding hospital admission wherever possible.
Even before Darzi’s report was published, Labour announced plans to develop a by diverting billions of pounds from hospitals into primary care.
But to avoid fights between local NHS organisations for scarce resources, it may be wise to reform how NHS budgets are allocated. For example, joint funding across hospitals and primary care could be used to develop new forms of neighbourhood care. Evidence on shows how NHS bodies (with the right incentives) can fund and organise whole pathways of care across different organisations, making services more accessible for patients.
In a highly centralised service such as the NHS, there will be temptation to dictate reforms from the centre. But for such large-scale changes to work, they need to be – involving staff (especially doctors) and patients throughout.
From treatment to prevention
In his review, Darzi talks about “the power of prevention” – linking this to reduced pressure on NHS services, improvements in people’s health, and boosting the economy as more people could remain in work. Placing a stronger focus on preventing disease has been a .
Since the report’s publication, the government has already announced it will roll out in a bid to improve public health and prevent disease. This involves banning junk food ads on TV pre-watershed – with online ads for such products banned altogether. The government will also take forward the , which would impose further limits on cigarette sales and vape marketing.
There are also other examples of disease prevention undertaken at the community level on which the government can draw. These initiatives have typically been developed through strong, collaborative work by local government alongside the NHS.
For example, the was an informal agreement between the local council and its citizens to commit to their health. The council worked with local NHS and other services on an overall preventative approach – giving staff more freedom to make decisions about services when working with patients, and focusing on the strengths of local communities. Evidence so far shows it’s led to some improvements in in the area – bucking the national trend.
But moving from treatment to prevention will require long-term investment and action across government departments, as many of the are rooted in poverty, poor housing, unemployment, and lack of access to early years education. Health services play but one part in this. It’s vital local NHS organisations are supported in being to improve health through prevention.
Potential pitfalls
To achieve its mission to reform the NHS, the government needs to avoid three major pitfalls.
First, it must avoid the temptation to do everything from the centre – trusting instead in local organisations and teams, within a proportionate framework of accountability.
Second, it must avoid poor implementation of reforms by to make the profound changes needed – even though this will probably be politically contentious.
Third, the reforms must avoid a major and distracting structural . Politicians and policymakers must concentrate on making tough, long-term improvements in local patient services instead of – yet again – changing NHS structures in ways that will have little effect on how care is delivered.
