NHS must ‘reform or die’, Sir Keir Starmer says as major report is published

The NHS must reform or die, Sir Keir Starmer will say, as a major report on the health service is published.

The Prime Minister will set out his plans for tackling long waiting lists, improving the nation’s health and shifting the focus towards community services after a damning report from Lord Darzi found the NHS is “in serious trouble”.

The rapid review, completed in nine weeks, diagnoses the problems in the NHS and sets out themes for the Government to incorporate into a 10-year plan for reforming the health service.

The study argues the NHS is facing rising demand for care as people live longer in ill health, coupled with low productivity in hospitals and poor staff morale.

Speaking at an event in London on Thursday, the Prime Minister will say: “The NHS is at a fork in the road, and we have a choice about how it should meet these rising demands.

“Raise taxes on working people to meet the ever-higher costs of an ageing population – or reform to secure its future.

“We know working people can’t afford to pay more, so it’s reform or die.”

Sir Keir will pledge to work on three fundamental areas of reform to make the NHS fit for the future.

He will say this “could amount to the biggest reimagining of our NHS since its birth”, adding: “This Government is working at pace to build a 10-year plan. Something so different from anything that has come before.

“Instead of the top-down approach of the past, this plan is going to have the fingerprints of NHS staff and patients all over it.

“And as we build it together, I want to frame this plan around three big shifts – first, moving from an analogue to a digital NHS. A tomorrow service, not just a today service.

“Second, we’ve got to shift more care from hospitals to communities… And third, we’ve got to be much bolder in moving from sickness to prevention.”

Lord Darzi, a widely respected surgeon and former health minister, argues in his report that the NHS can be fixed.

He says: “Nothing that I have found draws into question the principles of a health service that is taxpayer-funded, free at the point of use, and based on need not ability to pay.”

Lord Darzi says the country “cannot afford not to have the NHS, so it is imperative that we turn the situation around”, adding that the health service “is in critical condition, but its vital signs are strong”.

He criticises political decision-making under the Conservatives and the coalition government, including the impact of austerity and the reorganisation of the NHS under Andrew Lansley in 2012.

In his report, Lord Darzi says the “Health and Social Care Act of 2012 was a calamity without international precedent. It proved disastrous”.

He continues: “In the last 15 years, the NHS was hit by three shocks – austerity and starvation of investment, confusion caused by top-down reorganisation, and then the pandemic which came with resilience at an all-time low.

“Two out of three of those shocks were choices made in Westminster.”

His report also set out how:

– The health of the nation has deteriorated, with more years spent in ill-health. Factors affecting health, such as poor quality housing, low income and insecure employment, “have moved in the wrong direction over the past 15 years, with the result that the NHS has faced rising demand for healthcare from a society in distress”.

– There has been a “surge” in multiple long-term conditions, including a rise in poor mental health among children and young people. Fewer children get their vaccines and fewer adults now participate in things such as breast cancer screening.

– Waiting times targets are being missed across the board, including for surgery, cancer care, A&E and mental health services. The report says “long waits have become normalised” and “A&E is in an awful state”, with long waits likely to be causing an additional 14,000 more deaths a year, according to the Royal College of Emergency Medicine. By April 2024, about one million people were waiting for mental health services. The overall NHS waiting list stands at 7.6 million.

– People are struggling to see their GP. “GPs are seeing more patients than ever before, but with the number of fully qualified GPs relative to the population falling, waiting times are rising and patient satisfaction is at its lowest ever level.”

– Cancer care still lags behind other countries and cancer death rates are higher than in other countries. There was “no progress whatsoever” in diagnosing cancer at stage I and II between 2013 and 2021. However, more recent figures show some improvement.

– Progress in cutting death rates from heart disease has stalled while rapid access to treatment has deteriorated. For example, the time for the highest-risk heart attack patients to have a rapid intervention to unblock an artery has risen by 28% from an average of 114 minutes in 2013-14 to 146 minutes in 2022-23.

– The NHS budget “is not being spent where it should be” and too great a share is being “spent in hospitals, too little in the community, and productivity is too low”. Too many hospital beds are taken up with people needing social care.

– Between 2009 and 2023 the number of nurses working in the community fell by 5%, while the number of health visitors dropped by nearly 20%.

– At the start of 2024, 2.8 million people were economically inactive due to long-term sickness, with most of the rise since the pandemic down to mental health conditions. The report said “being in work is good for wellbeing” and having more people in work grows the economy. “There is therefore a virtuous circle if the NHS can help more people back into work.”

– Raids on capital budgets have left the NHS with crumbling buildings and too many outdated scanners, and “parts of the NHS are yet to enter the digital era”. The report says the “NHS is in the foothills of digital transformation”.

– The NHS delayed, cancelled or postponed far more routine care during the pandemic than any comparable health system.

– Too many NHS staff are “disengaged” and there are “distressingly high-levels of sickness absence”. The pandemic was “exhausting” for many and the result has been a “marked reduction in discretionary effort across all staff groups”.

– Regulatory-type organisations now employ some 7,000 staff, or 35 per NHS provider trust, having doubled in size over the past 20 years.

As part of his recipe for reform, Lord Darzi says the Government must “re-engage staff and re-empower patients” and must “lock in the shift of care closer to home”.

In his speech on Thursday, Sir Keir will also point the finger of blame for the current state of the NHS at the Tories, saying it is “unforgivable”.

He will say: “People have every right to be angry. It’s not just because the NHS is so personal to all of us – it’s because some of these failings are life and death.

“Take the waiting times in A&E. That’s not just a source of fear and anxiety – it’s leading to avoidable deaths.

“People’s loved ones who could have been saved. Doctors and nurses whose whole vocation is to save them – hampered from doing so. It’s devastating.”

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: “It makes absolute sense to shift resources into primary care, where patients want to be cared for and where delivering care is most cost effective.”

Conservative shadow health secretary Victoria Atkins said: “We will review this report carefully but it appears that Labour have missed an opportunity to put together meaningful plans for reform.

“We Conservatives recognise that investment has to be married with reform, this is why we brought forward long-term plans for productivity, tech, Pharmacy First, virtual wards, attracting pharmaceutical research and training and retaining staff.

“We did this whilst boosting investment in the NHS in real terms every single year.

“The Labour Government will be judged on its actions.

“It has stopped new hospitals from being built, scrapped our social care reforms and taken money from pensioners to fund unsustainable pay rises with no gains in productivity.

“They need to move from rhetoric to action.”