Darzi’s NHS review shows depth of problems for Labour

Rhetoric meets reality

First is when to shift from problems to solutions. As with the economy,7 Labour’s political narrative on the NHS so far has emphasised the depth of the crisis inherited from the Conservatives. The health secretary, Wes Streeting, declared the NHS “broken” on his first day in the job.8 Darzi’s review adds heft to this narrative and helps Labour extend the story further. In his response to the review, the prime minister, Keir Starmer, said that “until this morning, we didn’t know the full scale of the damage.”9 This line may buy time. But the responsibility for fixing these problems now belongs to Labour. The government has pointed to broad changes it wants to make to help address these challenges, such as shifting care from hospitals to the community.10 But detail on how is lacking. And the rhetoric of “reform or die”9 may alienate some professional groups needed to deliver the changes.

Second is which problems Labour should prioritise. Darzi was asked to focus on the NHS, and his diagnosis runs to more than 150 pages and several hundred more of technical annexes. Yet the task of improving the nation’s health is about more than the health service—as Darzi acknowledges.

Health and health inequalities are shaped by social, economic, and environmental factors, such as income, jobs, and housing.11 Take this broader lens and the list of problems grows longer. Since 2010, life expectancy in England has stalled, and health inequalities between richer and poorer areas have widened.12 Public health budgets have been cut,13 and investment in wider services that shape health has been weak.14 Labour knows this and has set ambitious goals to reduce health inequalities through a “health in all policies” approach.10 But the risk is Labour’s health mission gets skewed towards the NHS—and skewed even further towards meeting high profile targets to reduce hospital waiting lists.

Third is how quickly Labour can address these problems. Labour has promised to meet key NHS performance standards, such as at least 92% of patients starting consultant led treatment within 18 weeks of a general practitioner referral, within five years.151617 Yet these targets have been routinely missed for nearly a decade.18 Returning them in half that time is unlikely without substantial increases in NHS funding and capacity.19 Darzi seems to agree: the review states that “it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term.”1 Might Darzi be used as political cover to plot a more pragmatic path to recovering NHS performance?

And fourth is the mismatch between Labour’s ambitions on funding and reform. Darzi points to underinvestment as a root cause of the NHS crisis. This includes weak capital investment compared with other European countries, such as France and Germany.20 Recent analysis suggests that NHS spending would need to grow by around 3.8% a year in real terms over the next decade—much higher than current projected spending—to achieve the kind of improvements set out by Labour.21 But the health secretary has emphasised reform over investment22 and—in his recent speech on the NHS—Starmer said, “we have to fix the plumbing before turning on the taps.”9 Policy change is no doubt needed to redefine NHS priorities, align public policy levers—such as targets, regulation, and payment systems—behind them, steer new technology towards the NHS’s objectives, and more. But Labour should remember that its last round of reforms responsible for turning around NHS performance in the 2000s did so backed by annual spending growth of close to 7%.2324