The review of the NHS by Lord Darzi, released today, revealed a stark analysis of the current state of the NHS.
Commissioned by Health Secretary, Wes Streeting, the report stresses that the NHS is in "serious trouble" due to long-standing issues, including the backlog of waiting lists, staffing shortages, and poor infrastructure.
In the report, Lord Darzi suggests that while the NHS remains resilient thanks to its dedicated workforce and public support, systemic problems could take up to eight years to resolve without urgent reforms.
Underinvestment in Infrastructure and the New Hospital Programme
One of the main findings in the report is the underinvestment in Infrastructure: “The NHS has been starved of capital and the capital budget was repeatedly raided to plug holes in day-to-day spending,” the report states.
Touching on the New Hospital Programme, the report stated that underinvestment in infrastructure has resulted in “crumbling” buildings and a delay in NHS Trusts entering the digital era.
The report also revealed that “some £4.3 billion was raided from capital budgets between 2014-15 and 2018-19 to cover in-year deficits that were themselves caused by unrealistically low spending settlements.”
Lord Darzi states that “these missing billions are what would have been invested if the NHS had matched peer countries’ levels of capital investment in the 2010s.”
As well as preventing backlog maintenance, modernised technology, and equipment, the “missing billions” could have “paid for the 40 new hospitals that were promised but which have yet to materialise,” according to Lord Darzi in the report, as well as “rebuilt or refurbished every GP practice in the country.”
“Instead, we have crumbling buildings, mental health patients being accommodated in Victoria-era cells infested with vermin with 17 men sharing two showers, and parts of the NHS operating in decrepit portacabins. 20% of the primary care estate predates the founding of the health service in 1948,” Lord Darzi states in the report."
The 40 new hospitals were initially promised by the former Conservative Government as part of its New Hospitals Programme which as of 2024, has progressed at a much slower pace than expected and is currently facing delays and funding issues.
Last year, the Department of Health and Social Care, under the Conservative Government, found that out of the 42 NHS hospitals constructed with reinforced autoclaved aerated concrete (RAAC), seven needed a full rebuild "given the risks these buildings pose to patients and staff," according to the Department of Health and Social Care.
Reactions from NHS Trusts with a hospital most affected by RAAC
Building Better Healthcare got the reactions to the review from some of the NHS Trusts with the seven hospitals most affected by RAAC.
The Queen Elizabeth Hospital, King's Lynn NHS Foundation Trust
Paul Brooks, Director of Estates and Facilities, said: "The Queen Elizabeth Hospital King’s Lynn fully understands the Chancellor’s need to ensure all public money is used to deliver the greatest value for taxpayers. We believe our case for a new building remains strong, we are investment ready and we remain on track to deliver a new hospital by 2030. Our longstanding issues with Reinforced Autoclaved Aerated Concrete (RAAC) mean that we are in the fourth year of a rolling safety programme to create a steel support structure. The safety of our patients, staff and visitors remains our top priority."
Leighton Hospital, managed by Mid Cheshire Hospitals NHS Foundation Trust
Board Senior Responsible Officer, Leighton Hospital New Hospital Programme and Estates Redevelopment, Russ Favager, said: "We are aware of the Government review of the NHP programme to develop a realistic and costed timetable for delivery, and we continue to work closely with New Hospital Programme to understand the details and what it means for our own plans."
West Suffolk Hospital, West Suffolk NHS Foundation Trust
A spokesperson from the Trust said: "The Trust is pleased the Government continues to support the New Hospital Programme, specifically their commitment to prioritise and replace RAAC hospitals. Whilst the Trust remains on target to deliver the replacement hospital by the end of 2030, it hopes the review does not inadvertently slow the momentum created within local schemes, particularly those replacing aged RAAC estate."
Airedale General Hospital, managed by Airedale NHS Foundation Trust
A spokesperson from the Trust said: "Whilst the government’s review of the New Hospital Programme is taking place we continue with our plans, working to our construction programme that will see us move into a new hospital by 2030."
"As one of the worst affected RAAC hospitals we are in urgent need of replacement. We have a comprehensive rolling programme of structural support work taking place across the hospital, as well as a thorough monitoring and inspection programme of all the RAAC planks. This work will continue to ensure the safety of our patients, visitors, and staff, until the time comes that we can move into our new hospital," the spokesperson continued.
The overall findings of the review and the key takeaways
Overall, the review suggests that the NHS needs a decade-long overhaul, with a combination of capital funding, policy shifts, and a digital transformation to bring it back to health.
The report is expected to shape upcoming reforms and a new 10-year NHS plan. As well as underinvestment in infrastructure other key findings of the report include:
Community care: The report states that the NHS budget focuses on hospitals and there is insufficient support for primary care and community services.
Consequently, Lord Darzi, in the report, suggests a rebalancing of resources to alleviate pressures on hospitals.
Workforce issues: Lord Darzi, states the ongoing issue of the NHS workforce being overstretched, but points out process inefficiencies like bed shortages hindering productivity.
Darzi also highlights the increasing number of people unable to work due to health issues, which impacts the economy.
The digitisation of the NHS: The report states that technical modernisation of the NHS, integrating digital solutions, can help streamline operations, reduce waiting times, and improve patient outcomes.
However, Lord Darzi, highlights that the digitisation of the NHS needs significant investment and a long-term plan to drive real digital transformation.