Thread by @danielgoyal

The Darzi Report (England only)

My thoughts…

🧵

Darzi seems to grasp - to some degree - the depths of the state of the NHS crisis.

Crucially, Darzi gets that primary care is grossly overwhelmed.
His Second paragraph highlights the FACT GPs are seeing more patients with less GPs.

A&E is a disaster.

And cancer waits are a travesty. Only 66% of patients receive treatment for cancer within two months of referral. It was over 85% in 2008.

The NHS has spiralled into a doom loop of reduced efficiency and falling productivity. (I assume the word “ringing” was meant to read “running”)

Massive sickness absence rates are in part related to a lack of access to healthcare. A strong healthcare system equals a strong economy.

Darzi gives four reasons for the collapse in access to healthcare

1. Austerity
2. Pandemic
3. Staff and patients engagement
4. Management

1. Austerity - near zero growth in the NHS over 14 yrs

Darzi comments on the increase in illness and complexity in patients. The nation is sicker. Demands are growing each year. But there has been “virtually” zero expansion in the NHS funding to account for this.

2. Pandemic

The big question is why the acute pandemic hit healthcare access so much more in the U.K. than other countries?

It’s stark

Our reduction in routine procedures was pretty much unparalleled.

I actually led a cross-speciality review of this very issue

In part, it was the extreme resistance the last govt had in expanding the NHS capacity.

thelancet.com/journals/lanep…

3. As for staff and patient engagement

This is a critical issue. The NHS has been run on the good will of staff for decades. Look at what has happened to the level of unpaid overtime staff now do:

And here is an example of just how far off the mark staffing levels are in the NHS. Midwives ⬇️

4. Management
Describes the Tory 2012 healthcare act as “a calamity without international precedent”…

Outlining the wilful destruction of the NHS by the last government. And a fact that will drive RW commentators mad - there are too few managers now!

But Darzi fails to properly hold to account NHS management and executives for their role in the failed pandemic response and failure to protect patients from govt policy. Although does say this

In terms of solutions:
Despite Darzi seemingly identifying key issues involved in the demise of the NHS (albeit he manages to avoid mentioning real term pay cuts or the efficacy of using NHS funds to private contractors), Darzi fails to follow through!

He was right that the first priority should be staff re-engagement and giving patients a voice. (Not seeing anything in the Labour plans as yet that will achieve this!)

Darzi is ultimately right that healthcare needs to move back into the community. Expanding primary care is an unavoidable step if we will ever get back to the NHS we had under the last Labour govt.

But Darzi somehow comes up with this doozy: “drive productivity in hospital”. I can only imagine how hard that was to write after detailing how burnt out staff are, how little capacity hospitals have to manage the burgeoning demands, and how there has been no growth in 14yrs

To say that “driving productivity” is a tenet of the solution is tough to square. Maybe Darzi is hoping the Labour govt put the pieces together themselves (he can’t give policy recommendations). Productivity means increasing capacity both GP and bed capacity.

Then talking about tech advancements. “Breakthrough” technology and “new treatments”. I find this hard to square with the level of crisis Darzi highlights. Not enough capacity to get an ambulance, GP, A&E, cancer Tx, angiogram,etc… And yet “breakthrough tech” is the answer?

We are back to basics, I’m afraid. As much as aspirational tech, AI, and prevention would be great, it can only remain aspirational until people can rely on getting their heart attack, stroke, cancer,… treated in a timely manner. For me “new treatment” seems like an odd priority

Overall, the analysis is decent (albeit feels somewhat selective), and the focus on GP and disease prevention is solid. Failure to explicitly state it all hinges on improving NHS capacity or staff working conditions just weakens the integrity of the report for me But who knows….

Maybe Streeting and Starmer will read it properly and join the dots and make some actual tough decisions - expand the NHS to meet the needs of the population. Only then can reform be safe, effective, and more than a political sound bite.
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(Video to follow)