How Darzi’s dossier of desolation sets the stage for a rebooted, more radical Long Term NHS Plan

The NHS is on ‘life support’ and needs ‘major surgery’. Years of increasing demand, systemic strain, and the challenge of the COVID-19 pandemic mean it is now time to ‘reform or die’.  

With rising public dissatisfaction, mounting waiting lists, and a system struggling to keep up with demand, Lord Darzi’s report is stunning in its frankness and makes for sobering reading. And while it’s the latest in Labour’s ‘look what we’ve inherited’ strategy, the report paints a picture that health leaders recognise. 

David Thorne, WA Health Adviser and Director of Transformation at Well Up North PCN said ‘It’s a true portrait of the difficulties faced from top to bottom in the NHS. But with this comes the chance to reform, transform and drive change.’ 

Labour intends to use the report as a platform to set out how it needs two terms in Government and a long-term mindset to overcome these major problems – doing so will need them to balance urgent against important, acute vs critical, and public demand vs operational and budgetary realities – Labour knows this, which is why the Darzi report is the precursor to a new ten-year plan being crafted by Professor Paul Corrigan, that will set out the how.  

Another one? Aren’t we five years into an existing NHS Long-Term Plan? One that was rich with thought and requested by the NHS itself?  

With some of the critical challenges sounding familiar, the temptation when the 10 year plan consultation eventually opens might be to dig out submissions from 2019! 

That would be a mistake. Darzi’s report does not make policy recommendations (as set out in its terms of reference) but if we take it to be the bedrock for the ten-year plan, Darzi has set the stage to go beyond the LTP, pushing for what may need radical and transformative reforms.  

How could this rebooted plan differ, and what new directions will it take to secure the future of the NHS? 

What’s familiar? 

Several key themes remain consistent but have evolved from 2019, particularly on prevention, digital transformation and workforce. 

1. Prevention and health inequalities: Both the LTP and Darzi stress the importance of prevention. Wes Streeting has also aligned to this heavily. But while the LTP focused primarily on reducing the burden of preventable diseases like smoking, obesity, and alcohol-related harm, Darzi has gone beyond and expanded the focus more heavily on issues including social determinants of health, recognising the impact of factors such as housing, income, and education on public health. The aim is to tackle these issues in a more integrated and community-focused way​.  

2. Digital transformation: Darzi has placed a major emphasis on AI, data integration, and enhanced digital tools to improve efficiency and patient care. The goal is to create a more digitally-enabled NHS that can respond to the needs of modern healthcare​. 

3. Workforce expansion and retention: The workforce crisis in the NHS remains one of its most pressing problems. While the LTP set out to increase the number of healthcare professionals, particularly in nursing and primary care, the Darzi report has also included issues such as re-engaging staff and tackling issues of burnout and low morale. Retaining existing staff and improving working conditions will be central to Labour’s long-term strategy to restore the NHS workforce​, with an early win in the bag via the Junior Doctor’s pay settlement.  

A more radical shift: What does Darzi tee up? 

Lord Darzi has created a platform for a much more radical and ambitious vision for the future. 

1. System reorganisation: One of the most significant changes will need to be in the way the NHS is structured and managed. 

The priority will be to shift more services out of hospitals and into community settings, with the intention to deliver care more efficiently and at a lower cost.  

Working within the current legislative architecture (which Darzi welcomes as a restoration of sanity), this may mean expanding integrated care systems (and giving local health bodies more decision-making power​ by ‘reinvigorating the framework of national standards, financial incentives and earned autonomy as part of a mutually reinforcing approach…’ 

2. Financial reforms: The Darzi Report highlights the imbalance in spending, with too much of the NHS budget going towards hospital care and not enough being directed towards primary and community care.  The report sets the need for a reallocation of resources. The new plan will therefore need to restructure NHS funding, ensuring that resources are used more effectively and in line with patient needs. 

3. Rebuilding and maintaining resilience: The COVID-19 pandemic exposed significant vulnerabilities in the NHS (see the COVID-19 Enquiries’ findings) particularly in its ability to manage public health crises while continuing routine care. Lord Darzi has therefore focused heavily on resilience and preparedness, and the need to ensure the NHS is better equipped to handle future emergencies​. There is now a greater understanding of how the UK fits into a global health system, supply chains and onshore capabilities. 

4. A focus on disease: After the focus on major conditions seen in the last few years, there is a notable focus on diseases. Again, many priorities remain from the LTP, but others appear to be scaled back or integrated into broader health strategies. Given Streeting’s noted prioritisation of cancer, mental health (particularly in children) and cardiovascular disease, these are unsurprisingly front and foremost of the report. Interestingly, diabetes looks set to be included within CVD and dementia care (a prominent part of the LTP) has dropped out.  

The path forward: Rebooting the NHS 

Darzi’s stark analysis means the upcoming ten year plan cannot just be another strategy in a long line of NHS strategies – the scathing diagnosis will springboard an opportunity for radical thinking.  

While the 2019 Long Term Plan laid the groundwork for important improvements, the Darzi Report makes it clear that more radical reforms are needed to meet the evolving challenges in the coming decade.  

The shift towards community-based care, better resource allocation, and pandemic preparedness signals a bold new direction for the NHS. 

In Lord Darzi’s words, “The NHS is in critical condition, but its vital signs are strong”.​ The new plan offers a real opportunity to rebuild the NHS into a more resilient, patient-centred, and forward-thinking institution. However, as the report acknowledges, it will take time to fully implement these changes.  

The challenge now lies in the effective execution of these reforms to ensure that the NHS not only survives but thrives in the years ahead.