Darzi Report Summarised

Reforms, revisions and the changing landscape of the NHS

Sep 16, 2024

Healthcare news has been set alight with the latest report by Lord Ara Darzi. Commissioned in July 2024 by Wes Streeting, the report titled “Independent Investigation of the National Health Service in England" has shed light on a number of issues that have plagued the health service.

We thought we’d take some of the key findings of this report and present them in this weeks newsletter. I’m sure you’ll find it an interesting read…

What are the key findings?

Lord Darzi sets out his report in a “clean & concise” way as he makes some short and punchy points. There are lots of other points but here are some we’ve found interesting:

People are struggling to see their GPs - There is a mismatch of clinicians to patients and access to healthcare is at an all time low
A&E is struggling - Here’s an excerpt that will explain this point; “In 2010, 94% of people attending a type 1 or type 2 A&E were seen within four hours'; by May 2024 that figure had dropped to just over 60 per cent.”
Two week waits are no longer two week waits - The 62-day target for referral to treatment has not been met since 2015.

What is the effect of these shortcomings?

Darzi points out two big problems. Falling productivity and increased sickness absence’.

I think we can all relate to reduced productivity as Darzi notes that it is directly correlated with reduced morale, the inability to upskill and the huge wastage of crucial clinician time as we drown in admin time in primary care with tasks or we’re constantly ringing around trying to make referrals and book beds. There’s also the anxiety associated with it all, as our threshold for admission gets lower and lower and we’re forced to take on more appointments (and admin).

The second is sickness absences’. Think about your own referrals for services such as mental health and musculoskeletal services. These are two of the biggest causes of long term sickness. It’s also noted by Lord Darzi that 50% of patients on a surgical waiting list are working age adults. This means that the huge waiting list for primary care, surgery and specialist services has resulted in more sickness, potentially snowballing into a disastrous situation for the health service.

So why is the NHS in such a difficult situation?

I guess this is the golden question. Darzi mentions four points. Of course, he is affiliated with the Labour Party so there will be indirect (or direct) jabs at the Tories. In summary, here are the points he mentions:

Austerity - This is specifically between 2010-2020 where NHS spending grew on average 1% per year in real terms. This is despite the increased complexity of patients due to changing demographics and patterns of disease. Spending has simply not reflected the needs of the population.
Pandemic - Darzi sheds some interesting insights here. He mentions that the UK cancelled more routine operations than most countries around the world. This meant there were less knee replacements, hip replacements, hernia repairs and other surgeries which has caused waiting lists to balloon.
Staff and patient ratio - Darzi doesn’t say anything we don’t already know. He mentions that the NHS is run on the good will of staff. The amount of overtime and unpaid work has increased dramatically over the years and this brings down staff morale.
Management - This is where he goes for the jugular. He argues that the management structure introduced by the last labour government in powers was dismantled by the Tories which led to a poor management structure in the NHS. However, there is no mention of the management and executives responsible for the failures during the pandemic.
What does the future hold?
Poor morale, poor access to care and a lack of funding are very low places to start from. Despite not being able to make policy recommendations, Lord Darzi mentions the following points (with some extrapolations from us):
- Move healthcare back into the community (…by expanding primary care?!). This means to increase recruitment and sticking with the NHS long term recruitment plan which we wrote about previously.
- Driving productivity - This possibly refers not only to increasing bed and staff capacity but also findings ways to drive more efficient process’. We think this may be linked to his next recommendation…
- Technology - Darzi, being an alumnus of Imperial College London will take pride in health technology. Despite not giving details, he feels that there needs to be more investment in technology that will help drive process.’ Maybe more technology like Accuryx? (If you know.. you know!)

Our Thoughts

The report was certainly an interesting read. The current situation is bad and unfortunately, we are now living the effects of a decade of cuts and poor recruitment. Like with all government sanctioned reports, there is always a touch of “government” in the findings. There is no explicit mention of the need to increase funding and drive recruitment.

We do believe that this report is intricately connected with other policy documents related to the state of the NHS which includes the NHS long-term recruitment plan. We’ve written about this previously here.

The government is likely to increase recruitment throughout the MDT including doctors, AHPs, pharmacists, paramedics and other professional groups as well as introducing extended roles to try and improve access to care.

As musculoskeletal and mental health have been specifically highlighted, it could be that clinicians will be incentivised to contribute to such services. First contact physio has been a game-changer but what happens next is key. This could mean greater opportunities for clinicians countrywide to retrain or up-skill in certain areas

However, much of this depends on funding. The NHS is stretched but as Lord Darzi mentions, a free to access health service is the best way to run a health service. With the exception of the United States, the entire world has followed the model of the NHS and immediate investment is required to sustain our health service.

So… Where does Pareto fit into this?

We like to keep an eye on policy as we always aim to provide contemporary education for the modern clinician. We’re here to “upskill the MDT” and that’s been our motto from day dot. As you can see, increasing access to healthcare is one the central pillars of the Darzi report and we have long recognised the following themes:

Healthcare staffing and recruitment is changing. We have moved beyond the doctor, nurse and pharmacist model.
The rise of an MDT culture means that we should be ready to draw on the skills and insights of our professional peers.
The introduction of extended roles means that clinicians require ongoing, up to date clinical education at times that are convenient to them
Clinical education needs to be solution orientated. This means that it needs to be reflective of real life scenarios such as consultations, disease management, interpretation of pathology and referrals based.

We work very hard behind the scenes to work with practices and hospitals to understand what clinicians need. Please do take a moment to check out our CPD events which I’m sure will surely add to your knowledge and experiences as a clinician. Join us this Sunday where we delve into the world of gynaecology.