The National Health Service (NHS) in England has long faced challenges, so The Lord Ara Darzi’s grim assessment of its condition comes as no surprise.
The report recognised that the system is in "serious trouble," with emergency rooms in an "awful state," waiting times soaring, and people struggling to see their GP.
Prime Minister Keir Starmer has pledged to confront “loud opposition” to his proposed public health measures and NHS reforms, following a major inquiry that revealed the health service is “in critical condition.”
Starmer announced he is ready to implement “controversial” measures to address the NHS and public health issues in England.
Speaking at the King’s Fund, Starmer emphasised his commitment to “major surgery, not sticking plasters” for the NHS, and vowed to adopt “much bolder” strategies to prevent illness.
He declared that the NHS must “reform or die” and warned that the necessary changes would take a decade to implement. “We need the courage to pursue long-term reform—major surgery, not sticking plasters. We must confront the challenges of an ageing society and a growing burden of disease,” he stated.
The Darzi report revealed that years of neglect had left the NHS “in critical condition,” struggling to meet the rising demand from an ageing and increasingly ill population. It highlighted that A&E departments were in “an awful state,” with long waits potentially contributing to 14,000 extra deaths annually.
Increased demand and ongoing recruitment problems
Speaking about the immediate changes should be prioritised to ensure timely patient care and prevent such tragedies, Dr Shriti Pattani OBE, an accredited specialist in Occupational Medicine, said, “I have been a doctor in the NHS for 33 years. I do not work in A&E so it is difficult for me to comment as I have not experienced the current climate. The challenges faced by A&E vary nationally depending on local populations needs and population density. However, the core issues around higher patient demand, combined with difficulty in recruitment of adequately trained staff remains a problem countrywide.
“In terms of one immediate change, I would like to share my experience of working with A&E during Covid in 2024. Staff in A&E who would normally have different shift patterns were rotated together on the same shift pattern which fostered good team work, psychological safety and this boosted morale at a very difficult time. We know that improved staff morale leads to reduced sickness absence, improved patient care and better clinical outcomes,” she added.
Shriti underscored that whilst more staffing is important, we need trained staff who feel valued and supported to encourage them to continue giving service to the NHS. She said, “Resource allocation is a constant dilemma in the NHS as there are competing needs and often resources are used for ‘fire fighting’ because of the pace and demand of the work. In my national role I look forward to working with the current government to help address staffing challenges including sickness absence, retention and increase in mental health among staff.”
Dr Prabhu Rajendran, a Consultant Paediatrician and RCPCH Ambassador said, “It is refreshing to hear the PM reaffirming that the NHS is still the right model and also the honest acknowledgement of the current state of the NHS. Major change to rebuild our NHS requires positive energy. I can see the intent and the desire to help drive reform and improvement. But this can't be achieved without addressing the root cause of understaffing.”
“Demand for NHS services is growing faster than the workforce, and we have not been able to recruit or retain staff. The NHS should intensify its recruitment efforts by collaborations using their global health partnership. Let us use this reorganisation to reset the system in the right way,” he added.
Dr Arjun Ghosh, a consultant cardiologist at UCLH and Barts Heart Centre said, “There has been chronic underfunding of the health service for over 10y. This has led to the NHS falling dramatically in most global health outcome indices. Worryingly doctors have not been listened to and more emphasis has been given on management consultants invented "fixes" which have universally led to worse productivity, clinical results and staff morale. The new government needs to listen to the concerns of doctors on how to rebuild the NHS.”
‘I waited over 14 hours in the A&E’
Speaking about the long waiting times in the NHS, especially in accident and emergency, Mrs Kalapan Purohit stated that, “I waited over 14 hours in the Accident and Emergency department due to my asthma and breathing issues. The extended wait was incredibly challenging, and the lengthy delay in receiving care was difficult to endure. One time, during my long wait, I was eventually called for a blood test. The nurse informed me I would need to wait for an hour after the test. My daughter, concerned about the delay, inquired about my situation and noted that I had been waiting for an unusually long time.
Kalapan emphasised that elderly individuals should receive priority in emergency departments because they often struggle with long waits. She said, “Many cannot sit for extended periods and may need assistance for basic needs like using the bathroom. While it's important to attend to all patients, giving priority to the elderly can ensure they receive the care they need more promptly and with greater consideration for their limitations.”
Amrita Balachandran* whose husband recently went to A&E with a broken toe, described their frustrating experience. She said, “We initially went to A&E where an X-ray of my husband’s toe showed no fracture. However, as an athlete, he frequently visits a private physiotherapy clinic. They felt something was wrong and referred him for a private MRI scan, costing us £300, which revealed a fractured of the sesamoid bone. So we took the scan results to the GP, who said that referral to the fracture clinic would take 3 to 4 weeks. Then he advised me to return to A&E for a quicker visit to an orthopaedic doctor.
“At A&E, we waited almost for six hours on a Monday night, only to have nurses, rather than an orthopaedic doctor, examine him. The nurses initially tried to rush us and dismiss his case. After some persuasion, she agreed to refer my husband to the fracture clinic, but only for a virtual appointment—a suggestion we found inadequate for a fractured foot. Given the uncertainty, went decided to see an orthopaedic doctor privately. We paid another £300 for that appointment, another £180 for a specialist boot and received care instructions. Meanwhile, the NHS fracture clinic promised to call to check on the broken toe ‘virtually’ and warned that if we missed the call, they would discharge my husband from the clinic. But eventually after much persuasion they have now sent an in-person appointment after 2 weeks. We sincerely hope they don’t cancel it at the last minute.”
* Name changed to protect anonymity