Darzi review 2024

In July 2024, the Labour Government’s Health Secretary ordered a rapid review of the state of the NHS by Lord Darzi. The review report was published on 12 September 2024.

What is the Darzi review 2024?

Following the election of the new Labour Government in July 2024, the Health Secretary, Wes Streeting, commissioned a full and independent rapid review into the state of the NHS. The review was completed by the Rt Hon Professor Lord Darzi, OM, KBE. On 12 September 2024, he published his report which highlights keys areas for improvement within the NHS to ensure delivery of high quality and efficient patient care.

Terms of reference

The review, completed in nine weeks, assessed patient access, quality of care and the overall performance of the health system and identifies themes and concerns to be incorporated into the government’s 10-year plan for reforming the health service, but does not make specific recommendations.

Key issues

The review identifies a number of key factors that are impacting on the performance of the NHS and acknowledges that some of these relate to wider issues rather than the operation of the health service.

The health of the nation has deteriorated

Social determinants of health, such as poor-quality housing, low income and insecure employment have impacted on the nation’s health over the last 15 years. There has been an increase in multiple long-term conditions and mental health issues, particularly among young people. A 25% real terms cut since 2015 to the public health grant, provided to local authorities by the health department, has exacerbated poor public health.

Spending has reduced and is poorly distributed

NHS spending has decreased since 2010 and is not being allocated to priority areas, in particular care in the community. This has reduced productivity and through-flow of patient appointments and procedures in hospitals despite increased staffing. The lack of social care capacity in the community means 13% of NHS beds are occupied by patients waiting to be discharged with social care support.

Waiting lists are unsustainable

Long waiting times have become normalised and are causing an additional 14,000 more deaths a year, according to the Royal College of Emergency Medicine. By April 2024, around one million people were waiting for mental health services and in June 2024 the overall NHS waiting list stood at 7.6 million.

Impact of the pandemic

The NHS delayed, cancelled or postponed more routine care during the pandemic than any other comparable health system. Furthermore, following the pandemic, NHS staff have become disengaged and there are high-levels of sickness absence — as much as one working month a year for each nurse and each midwife working in the NHS. The aftermath of the pandemic has continued to affect staff morale and physical and mental health and there has been a marked reduction in discretionary effort across all staff groups.

General practice

The UK has 15.8% fewer GPs per 1,000 population than the OECD average. The number of GPs per 100,000 population declined by 1.9% a year between 2016 and 2024, with the number of GP partners falling sharply and the number of GPs choosing to work part-time increasing. This has occurred at a time when GPs are expected to deliver a wider range of services.

Maternity services

Maternal deaths have increased since the pandemic. There are significant inequalities that exist in maternity care, for instance, black women are almost three times as likely as white women to die in childbirth. Neonatal mortality of the most deprived quintile is more than double that of the least deprived. Complexity of maternal health continues to steadily rise as the age that women become pregnant increases and more expectant mothers have other conditions, such as obesity. The number of births has fallen whilst the number of midwives has risen suggesting that “capacity alone does not appear to be the constraint on improvement of maternity services”. Skills, staffing mix, clinical models, leadership and culture are also key.

What next?

Lord Darzi concludes that “the NHS is in critical condition, but its vital signs are strong” as it is filled with staff who have a “shared passion and determination to make the NHS better for our patients.”

Whilst it remains to be seen how the government will respond in its 10-year plan for the health service to the issues identified by the Darzi review, the Prime Minister recently warned that the NHS is at a “fork in the road” and it must “reform or die” promising three ‘big shifts’ in its approach:

• Using more technology to create a “digital NHS”
• Shifting more care out of hospitals and into communities
• Moving from treating sickness to focusing on prevention

Lord Darzi has indicated there is no quick fix but the improvements we all hope for will take time, commitment and major financial, practical and system-wide support. Leaders across the NHS are embedding new, more collaborative ways of working and ministers will now need to help the NHS prepare for the long term through its planned ten-year strategy.