The Darzi report reveals the dire state of the NHS, but the signs are that the government is preparing for more privatisation of the service, rather than funding it properly, argues Lucy Nichols

The Darzi report largely confirms what we all knew to be true about the NHS. It outlines the major issues that have transformed the NHS from one of the best healthcare systems in the world into one that can barely function. Lord Darzi, a surgeon and health minister under Blair and Brown, found a number of serious issues in the NHS, which he says has been ‘starved’ of funding.

He details problems in waiting times, with target waiting times for treatment being missed across the board. There are serious delays in cancer care, meaning that the UK is lagging behind comparable countries in cancer care and has much higher levels of cancer deaths than comparable countries.

Staffing remains a serious problem in the NHS, which has 100,000 job vacancies. Since 2009, there are 5% fewer community nurses and 20% fewer health visitors. Though he pays tribute to health workers, who are ‘bound by a deep and abiding belief in NHS values and … a shared passion and determination to make the NHS better for our patients’, Darzi also found a high level of disengagement of staff with the NHS, and that more and more NHS workers are taking time off sick.

The population as a whole is much sicker today than it was fifteen years ago: poor-quality housing, low income and insecure employment have contributed to the rising need for NHS services as people become sicker. Mental ill health in children and young people is also on the rise, as more people suffer from more than one health condition.

Even prior to the pandemic, the NHS was in dire straits. Decades of underfunding and privatisation had created a health service barely able to deal with a winter crisis, let alone Covid-19. By March 2020, there were just 7.3 critical care beds per 100,00 people in the UK, compared to 43.2 beds in the Czech Republic at the time, or 28.2 in Germany. The Conservatives did undeniable damage to our health service. Labour seems set to do the same.

Ideological battle

The Darzi report is worrying not only because it exposes the problems in the NHS, but because it has opened the door for the Labour Party to wage an ideological war on the health service. Starmer has already proven his commitment to rolling back on public spending, through the scrapping the winter fuel allowance and refusing to put an end to the two-child benefit cap. His comments that the NHS needs to ‘reform or die’, and that there will be no ‘extra funding without reform’ are misleading and help push the idea that the problem with the NHS is that it is badly managed and inefficient, and therefore money spent is being wasted.

Streeting’s ‘three big shifts’ encourage the idea that the NHS is outdated and wasting money and time caring for people with ‘preventable’ health issues. The health secretary argues that we need to move ‘from hospital to community care’, ‘from treating sickness to preventing it’, and ‘from analogue to digital’. These three ‘shifts’ may at first sound sensible, but actually do nothing to address the issues in the NHS, and will allow Wes Streeting to skirt round real fixes towards his own political agenda.

It is true that ‘community care’ needs more funding. Hospital beds are filled with people who should be discharged, but have nowhere else to go because of the crisis in social care. If Streeting wants to free up hospital capacity, he needs to fund social care properly, for instance by putting an end to the £1.5bn that leaks out of the care-home industry and into private companies each year.

Preventing sickness is also a key step in reducing pressure on the NHS. Starmer has so far suggested that this can be done by banning fast-food adverts before 9pm, stopping children from buying high-caffeine energy drinks and extending the smoking ban. This is a fantastically cheap way of blaming everyone but the government for the rising pressure on the NHS. As Darzi’s report has proved, poverty is the biggest factor in poor public health.

If we want a healthier – and therefore more economically active – population, we need to invest in public health. This means cleaner air, better access to healthier foods and improving people’s living conditions, for instance by investing in quality council housing rather than forcing people to live in mould-infested homes.

Class is a huge factor when it comes to health inequalities (as is race). Working-class areas are where you find the worst air quality, least access to outdoor spaces, and poorest living conditions. After decades of cuts to public-health services and steadily deteriorating living conditions, the UK is a place where only the rich can afford to be healthy while the poor can’t afford to be.

The health secretary’s desire to shift from ‘analogue to digital’ is one of his more sinister notions. Contrary to what Streeting may want you to believe, the NHS is not reliant on antiquated systems of doctors transferring handwritten notes to one another. Nor are NHS workers to blame for trying to make do with outdated resources that are prone to data leaks and failure. It is a convenient falsehood that NHS services are all ‘analogue’, and is probably an excuse for Streeting to continue along the last government’s course of using apps and AI, and cut out staff-to-patient face time.

The safety of NHS data is a serious concern, and a variety of data leaks have demonstrated that our data cannot be trusted to private companies. However, given Streeting’s commitment to using ‘spare capacity’ in the private sector to relieve pressure on the NHS, it isn’t a stretch to assume that this switch from ‘analogue to digital’ will involve handing over more data to private companies.

Don’t trust Labour with the NHS

The Labour Party has demonstrated a serious commitment to cutting back the welfare state early on in its tenure. The re-emergence of Alan Milburn, health minister under Blair, is doubly worrying and suggests a move towards even more privatisation and outsourcing in the NHS.

Starmer and Streeting have failed to identify poverty as a serious cause of ill health (and therefore as putting significant pressures on the NHS). The scrapping of the winter fuel allowance and the two-child benefit cap will almost certainly put peoples’ lives at risk, especially as fuel prices increase and the winter health crisis looms.

The Labour Party are not offering any solution to the crisis in the NHS, but the Darzi report has made it clear that something must be done to save the vitally important institution. Pressure must be placed on the government to properly fund the NHS, finally to cut out all private involvement and to learn from the mistakes of the past.