The dire state of England’s National Health Service (NHS) has been laid bare in a government-backed review led by former health minister Lord Ara Darzi.
The 142-page report, released this week, exposes critical issues facing the NHS after more than a decade of austerity measures, ageing infrastructure, and a growing demand for care.
“The NHS is now an open book,” Darzi concluded.
“The issues are laid bare for all to see.” His findings paint a stark picture of an overstretched, underfunded system that has been hit by years of inadequate investment.
For Labour Prime Minister Sir Keir Starmer, addressing these problems will be one of the biggest challenges his government faces.
The ‘missing billions’ and underfunded infrastructure
The review reveals the impact of what Darzi calls the “missing billions”—the shortfall in capital investment that has left the NHS struggling with outdated buildings and equipment.
Over the past decade, the NHS has spent almost £37 billion less on health assets and infrastructure compared to peer countries.
This shortfall has led to a backlog of over £11.6 billion in maintenance costs, affecting everything from hospital buildings to mental health services, with patients sometimes housed in “Victorian-era cells.”
Darzi notes that 20% of the NHS estate predates the founding of the service more than 75 years ago, with staff working with “too many outdated scanners” and limited access to digital tools.
The result, according to the report, is that productivity has been hit hard, leaving the NHS less able to meet the rising demand for services.
NHS budget misallocation: Too much in hospitals, too little in communities
The report highlights another longstanding issue: the failure to shift care away from hospitals and into communities.
Despite pledges from successive governments to invest more in preventive and community-based care, the opposite has happened.
The number of community-based nurses has declined by 5% since 2009, while health visitors—crucial in early childhood care—have fallen by 20%.
Darzi argues that too much of the NHS budget is spent on hospitals, leaving primary care underfunded.
This has made it more difficult to address health issues early, leading to more patients requiring costly hospital treatments.
The report suggests that a shift in focus toward primary care could help prevent serious conditions from developing and ease the pressure on hospitals.
Premature deaths and ballooning waiting lists
One of the most troubling conclusions of the review is the rising number of premature deaths linked to ballooning waiting lists.
The Royal College of Emergency Medicine estimates that an additional 14,000 deaths per year can be attributed to delays in accessing care—more than double the total number of British armed forces combat deaths since the NHS was founded in 1948.
The report notes that waiting times for hospital procedures have surged, with around 7.6 million people currently waiting for routine appointments.
Emergency care is also struggling, with 1 in 10 patients waiting more than 12 hours for A&E treatment.
Mental health services are similarly overwhelmed, with more than a million people, including 100,000 children, waiting over 12 months for access to care.
Long waits have become “normalised,” Darzi says, adding that cancer mortality rates in England are higher than in other high-income countries, and no progress has been made in improving early cancer diagnosis since 2013.
A growing and ageing population: Pressures mount
Darzi’s report also points to the growing and ageing population as a key driver of pressure on the NHS.
England’s population is projected to increase by 13 million people by 2070, with two-thirds of this growth among those aged 65 or older—the age at which health costs per person begin to rise sharply.
The report warns that public health has “deteriorated,” with more people living longer with multiple conditions, placing additional strain on the NHS. Housing standards, income inequality, and lifestyle factors are all contributing to this growing demand.
The percentage of children living in poverty has risen to 29%, while the prevalence of depression has more than doubled from 5.8% in 2012 to 13.2% in 2022.
NHS staff morale: Disengagement and high sickness rates
The review also reveals alarming signs of disengagement among NHS staff. Since the pandemic, high levels of absenteeism have become common, with staff taking as much as one month off per year due to sickness.
Darzi stresses that improving working conditions is essential not only for staff morale but also for increasing productivity within the NHS.
Labour’s reform plan: A digital and community-focused NHS
The Labour government has pledged to overhaul the NHS, with Prime Minister Starmer vowing to carry out the “biggest reimagining of our NHS since its birth.”
The government will publish a 10-year plan for the NHS next spring, with three key priorities: moving the NHS from “analogue to digital” services, shifting more care from hospitals to communities, and focusing on preventing illness.
Starmer also highlighted the need to address the crisis in social care, which Darzi described as “dire.” Without proper funding, social care has placed an enormous burden on the NHS, particularly for elderly people and their families.
Starmer acknowledged that it is “not possible to build an NHS for the future if we don’t fix social care as we do it.”
A challenging road ahead
Darzi’s report underscores the depth of the challenges facing the NHS. Years of underinvestment, coupled with rising demand from an aging population, have left the health service in urgent need of reform.
The Labour government faces tough choices ahead, balancing the need for additional funding with the drive to implement long-overdue changes to improve care.
The road to recovery will not be easy, but Starmer’s government has made it clear that reform is essential.
The NHS remains a vital part of British life, and its future will depend on the government’s ability to address these deep-seated issues.
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