NHS does less despite record funding and must ‘reform or die’

Sir Keir Starmer will say on Thursday that the health service must 'reform or die'
Sir Keir Starmer will say on Thursday that the health service must ‘reform or die’

NHS hospitals are doing less work for their patients despite being handed more money than ever, a landmark report has found.

The investigation by Lord Darzi, a surgeon and former health minister, warns that the NHS is in a “critical condition” with surging waiting lists, poor cancer performance and a struggle to access care.

Sir Keir Starmer will say on Thursday that the health service must “reform or die”.

Lord Darzi’s damning report found that A&E wait times have swollen so much that a patient in need of care will now typically have 100 people ahead of them in the queue – up from just under 40 people in 2009.

Lord Darzi said the NHS had “more resources than ever before”, with funding of £165 billion – a record outside the pandemic. However, he warned there was an urgent need to boost productivity and shift more care out of hospitals.

His report found that staff were wasting ever more time because of a lack of beds, diagnostics and other kit.

Sir Keir to say in a speech on Thursday that working people cannot afford to pay more to fund the health service
Sir Keir to say in a speech on Thursday that working people cannot afford to pay more to fund the health service - PA

On Thursday, Sir Keir will say the health service must “reform or die” – and warn that working people cannot afford to pay more to fund it.

The independent investigation was ordered by Wes Streeting, a week after Labour won the election, when he declared the NHS “broken”.

The Prime Minister is expected to say that the NHS now faces a “fork in the road” about how to meet rising demands on it.

Speaking at an event in central London, he will say: “Raise taxes on working people to meet the ever-higher costs of an ageing population – or reform to secure its future.

“We know working people can’t afford to pay more, so it’s reform or die.”

Ministers have promised to publish a 10-year plan for the NHS in the new year.

Sir Keir will say it will be the “biggest reimagining of the NHS since its birth”, adding that far more care will be delivered in the community, rather than by hospitals.

He will also promise to move from an “analogue to digital NHS” and for the service to do much more to prevent ill-health as a worklessness crisis holds back the economy.

In his speech, Sir Keir will point the finger of blame for the state of the NHS at the Tories, saying it is “unforgivable”.

He will say: “People have every right to be angry. It’s not just because the NHS is so personal to all of us – it’s because some of these failings are life and death.”

Lord Darzi’s 142-page report found that while hospital staff numbers had risen by 17 per cent since 2019, there had been little change in output, with productivity at least 11.4 per cent lower than it was in 2019.

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The surgeon said far too much money had been ploughed into hospitals without investment in diagnostic equipment, beds and buildings.

As a result, the number of appointments, operations and procedures had failed to keep pace, with staff wasting much of their time phoning around wards in search of a bed.

The report stated: “With the NHS budget at £165 billion this year, the health service’s productivity is vital for national prosperity. Moreover, the NHS must rebuild its capacity to get more people off waiting lists and back into work.”

Far too much of the budget was being spent on hospitals, rather than providing care by GPs, Lord Darzi said.

He added that despite working in the NHS for more than 30 years, he had been shocked by what he found during the investigation.

A&E departments ‘deadlier than going to war’

Britain has long lagged behind other nations for cancer survival.

The investigation found that despite pledges to tackle the failure, “no progress whatsoever” was made in improving early diagnosis of cancer between 2013 and 2021.

“A&E is in an awful state,” the report stated, adding: “Had a patient arrived at a typical A&E on an average evening in 2009 (when sufficiently detailed data began to be collected to make this analysis possible) there would have been 39 people waiting in the queue. By 2024, this had increased to more than 100 people waiting at an average A&E department on a typical evening.”

The research suggested that A&E departments were deadlier than going to war. It said: “According to the Royal College of Emergency Medicine, these long waits are likely to be causing an additional 14,000 more deaths a year – more than double all British Armed Forces’ combat deaths since the health service was founded in 1948.”

And it warned that waiting times to see a GP were rising and patient satisfaction was at its lowest level ever, while waiting times for hospital procedures had “ballooned”.

Lord Darzi said the “dire” state of the NHS had been fuelled by austerity funding levels in the 2010s, which “starved” capital investment, and the 2012 top-down reforms of the service, which he described as a “calamity without international precedent.”

The report said these combined to leave Britain’s health service ill-prepared to cope with the pandemic.

As a result, the NHS delayed, cancelled or postponed much more routine care during the pandemic than any comparable health system, the report found.

Amanda Pritchard, the chief executive of NHS England, said: “Our staff are treating record numbers of patients every day despite ageing equipment and crumbling buildings, a surge in multiple long-term illnesses, and managing the long-lasting effects of the pandemic.

“While teams are working hard to get services back on track, it is clear waiting times across many services are unacceptable and we need to address the underlying issues outlined in Lord Darzi’s report so we can deliver the care we all want for patients.”


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