UK Prime Minister Keir Starmer cautioned on Thursday that Britain’s state-run National Health Service (NHS) must either reform or face collapse, following an independent report that described the institution as being in a “critical condition.”
Starmer, whose Labour Party secured a landslide victory in July, pledged to undertake “the biggest reimagining” of the NHS since its establishment 76 years ago. His remarks in central London came after the release of a 142-page investigation that revealed a decline in the health of Britons over the past 15 years.
NHS in a deteriorating condition
Ara Darzi, the report’s author and an unaffiliated Lord in the House of Lords, indicated that the NHS had deteriorated due to insufficient investment compared to other countries, top-down reorganization, and the impacts of the coronavirus pandemic.
Starmer highlighted the need for “courage to deliver long-term reform,” suggesting that major changes, rather than temporary fixes, were necessary. He projected that it would take a decade to restore the service. He described the NHS as being at a “fork in the road,” facing a choice between raising taxes to cover increasing costs due to an aging population or reforming to secure its future. Starmer emphasized that, given the financial strain on working people, reform was essential to prevent the NHS from failing.
Key areas for reform in NHS
The NHS provides free service at the point of use. Starmer outlined three key areas for reform as part of a 10-year plan to “turn around the NHS.” These included transitioning fully to digital systems, shifting more care from hospitals to communities, and focusing more on prevention rather than treatment. He assured that these reforms would not compromise the NHS’s founding principle of providing free treatment at the point of need and stated that additional funds would not be allocated without accompanying reform.
Labour’s election victory in July was partly based on a promise to “fix” the NHS, with accusations that the Conservatives had “broken” it during their 14 years in power. Starmer criticized the previous decade as a “lost decade” for the NHS, during which the Conservatives failed to prepare the service for current and future challenges.
NHS report
Darzi’s report highlights a rise in patients with multiple long-term illnesses, such as diabetes and high blood pressure, as well as higher cancer rates compared to other countries and lagging treatment for major conditions. It also pointed out that waiting lists had reached 7.6 million and that a significant proportion of accident and emergency patients now wait over 12 hours before receiving care.
Darzi expressed surprise at his findings but noted that the NHS’s core functions remained robust. Over a year ago, Rishi Sunak, then the Conservative Prime Minister, had announced a 15-year plan to recruit over 300,000 staff to address a severe shortage of doctors and nurses, with projections indicating a potential shortfall of 360,000 by 2037 due to an aging population, insufficient domestic training, and new visa rules affecting recruitment and retention.
Starmer, whose mother worked as an NHS nurse, has been critical of the Conservatives’ management of various sectors, including health, and has used his early tenure to blame them for the poor state of affairs. The Conservatives, led by Sunak, who is the son of an NHS doctor and a pharmacist, have accused Starmer of exaggerating the issues to justify future tax increases.
NHS can still be saved
In his report, Darzi, a respected surgeon and former health minister, suggests that the NHS can still be saved. He stresses that nothing undermines the principles of a taxpayer-funded health service, free at the point of use and based on need, not ability to pay. He also argues that the country cannot afford to lose the NHS and must act to reverse the current crisis.
Darzi criticizes past political decisions, particularly the impact of austerity and the 2012 reorganization of the NHS under Andrew Lansley, which he describes as a disaster. The Health & Social Care Act of 2012, intended to reorganize NHS services, is seen as a calamity with no international precedent.
The report identifies three major shocks to the NHS over the past 15 years: austerity, top-down reorganization, and the COVID-19 pandemic, with two of these being political choices made in Westminster.
Darzi’s report outlines several critical findings, which include:
The nation’s health has declined, with more people spending longer in ill health. Social factors such as poor housing, low income, and insecure employment have worsened, driving higher demand for healthcare.
Long-term conditions and poor mental health, especially among children, have surged, and participation in vaccinations and cancer screenings has dropped.
Waiting times for surgeries, cancer care, and mental health services have been consistently missed, with long waits in A&E contributing to an additional 14,000 deaths annually. As of April 2024, one million people are waiting for mental health services, with the overall NHS waiting list standing at 7.6 million.
Fewer people are able to see their GP, with rising wait times and low patient satisfaction as the number of fully qualified GPs falls.
Cancer care is lagging behind other countries, with death rates higher. There was no progress in early-stage cancer diagnoses between 2013 and 2021, though recent data shows slight improvement.
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Progress in reducing heart disease deaths has stalled, and access to rapid treatment has deteriorated, with average wait times for the most at-risk heart attack patients rising by 28% from 2013 to 2023.
NHS funding is not being efficiently allocated, with too much spent on hospitals and too little on community care, resulting in low productivity.
The number of community nurses has dropped by 5%, while health visitors have declined by nearly 20% between 2009 and 2023.
As of early 2024, 2.8 million people are economically inactive due to long-term illness, with mental health conditions being the primary reason. The report notes the positive economic impact of helping people return to work.
Capital budget cuts have left NHS infrastructure in disrepair, with outdated equipment and a lack of digital transformation.
The NHS delayed more routine care during the pandemic than comparable healthcare systems.
NHS staff are increasingly disengaged, with high rates of sickness and reduced morale following the exhausting pandemic.
Regulatory bodies have grown significantly, with staff numbers doubling over 20 years.
Darzi calls for reforms to re-engage staff and empower patients, emphasizing the need for more localized care.
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