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The NHS at a crossroads: HCP response to 2024 Darzi report on the NHS

14.11.2024 | Health Strategy

The NHS at a crossroads: HCP response to 2024 Darzi report on the NHS

Introduction

The UK’s National Health Service (NHS) is both a revered institution and a critical public service facing immense pressures. Sixteen years ago, Lord Ara Darzi’s High Quality Care for All report set a bold vision for the NHS, championing quality, choice, and patient-centred preventative care. This vision, refreshed in Darzi’s recent 2024 follow-up, offers a candid assessment of both achievements as well as unmet goals set out a decade and a half ago. Darzi’s latest report has received strong reactions across the health and care community in the UK, especially regarding its emphasis on exploiting digital transformation opportunities and the urgent need for further structural reform. With over 400 mentions from healthcare professionals in recent discussions, his report has sparked a renewed debate on the path forward towards a more sustainable NHS in England.

Evolving priorities: quality care and accessibility

The 2008 report aimed to decentralise authority, empowering frontline clinicians to improve care at the local level. Today, the 2024 report reflects a new set of pressing issues, from the strain on GP services to prolonged emergency department wait times. Healthcare professionals on social media have emphasised that this decentralisation ambition remains unmet, particularly within GP services where staffing shortages are severe. With HCPs highlighting GP shortages as critical, it’s clear that the NHS’s growing reliance on improved access to primary care has strained the wider NHS system. Dr Paul Ash, for instance, noted the continued rise in wait times, especially in light of an ageing population, as a critical sign of the NHS’s declining efficiency​. He highlights the need for primary care providers to offer a broader range of services so as to reduce the need for onward referrals into secondary and more specialist care. Examples of such innovations are to be found in health systems in countries such as Switzerland, Sweden, and Germany all of which offer more specialised care in a primary care setting to cope with the increased demand on services because of an ageing population, some of the changes in these countries were accelerated because of the COVID-19 pandemic.

The quality journey: positive developments and gaps

Darzi reports on the limited progress that has been made in some areas since 2008, such as attempts to introduce more personalisation and prevention on diabetes care (p.5). For example, the Diabetes Prevention Programme and advancements in cancer screenings have been noted in the recent Darzi report (p.152), with significant improvements in lung cancer survival rates, which jumped from 54% to 76.6% of stage 1 and stage 2 lung cancers identified through the ‘Targeted Lung Health Check Programme’. However, making the most of digital opportunities to improve quality of outcomes for patients remains a significant challenge. In online discussions amongst HCPs, about 15% of mentions highlighted the need for increased digital adoption to be streamlined across the NHS, particularly regarding data-sharing platforms such as OpenSAFELY. As Professor Ben Goldacre pointed out, platforms like OpenSAFELY have demonstrated their potential through successful local implementation, yet broader implementation remains limited due to financial constraints​. Goldacre’s post had the most reach of all individual HCP posts analysed during September-October 2024, reaching 46,424 impressions. 

The unmet promise of preventive healthcare

Increasing the NHS system’s ability to provide more effective preventive care was one of the cornerstones of the 2008 vision, designed to reduce hospital admissions and foster healthier lifestyles. However, healthcare professionals are vocal in their criticism that limited investments and inconsistent support for community services have hindered the NHS’s ability to keep pace with rising public health demands. Several HCPs highlighted that immunisation rates have dropped by 10% over the last decade, while demand for mental health services has surged. Alison Morton’s response underlined that high-risk communities, including children and young families, are disproportionately impacted by gaps in these services.

Healthcare professionals have also highlighted the lack of progress in advancing preventive care. Many expressed concerns that while these areas were prioritised in the report, they have not been matched by sufficient investment. Steve Ford remarked that a significant amount of community health funding continues to be directed towards hospital-based treatment, leaving preventive and community healthcare chronically underfunded. This is specifically of importance as the 2008 iteration of Lord Darzi’s report emphasised the importance of preventative healthcare. “The focus on prevention, improved quality and innovation will support the NHS in its drive to ensure the best possible value for money for taxpayers.” Lord Darzi wrote in the introduction to his report in 2008 (p.15). 

The 2024 report reflects a mixed assessment on progress in preventative care. “While specific programmes, such as the Diabetes Prevention Programme, have yielded promising results—achieving nearly a 40% reduction in type II diabetes risk—the broader impact of preventative care initiatives remains limited. Key areas, including childhood obesity and smoking cessation, have not made comparable improvement strides.” (2024, p.152). The new report attributes these gaps to inconsistent investment and prioritisation, noting that preventive care efforts continue to be constrained by resource limitations and shifting funding priorities. 

A changing context: the impact of austerity and pandemic

Austerity in the 2010s combined with the impact of the pandemic have reshaped the NHS. Staff shortages, capital constraints, and skyrocketing patient demand now define its operational reality. Professionals and patient advocacy groups alike expressed frustration with the system’s lack of resilience, noting that an increasing number of NHS beds are now occupied by patients waiting for social care support. The British Geriatric Society remarked that while some of the 2024 report acknowledges increasing demand for health and care services, it does not fully capture the challenges that are faced directly outside of the NHS system, this post was shared by 11 HCPs. Rising challenges in social care further complicate NHS efforts to manage hospital and community care at scale​, not addressing the specific challenges faced by the social care sector will limit the full impact of improvements outlined in Darzi’s most recent report.

The path forward: priorities for transformation

Lord Darzi advocates a return to the NHS’s founding values with a stronger focus on equity, patient empowerment, and technology. For healthcare professionals, this message resonates, yet many feel systemic barriers remain unaddressed. Indeed, analysis in the British Medical Journal suggests that a significant increase in NHS funding is needed in primary care and community health sectors to achieve meaningful change, while others also argued that an increase in mental health funding was proposed by the professional community to meet current demand​, with 26 HCPs sharing the Royal College of Psychiatrists’ post collectively accumulating a total of 118,677 impressions.

 

 

The report calls for a “lock-in” of resources toward preventive care, community health, and digital infrastructure, stressing that “quick fixes” are now, and have always been, insufficient. Healthcare professionals have expressed scepticism, citing previous reports, including Darzi’s own 2008 report, which proposed similar solutions without sustainable and measurable change. They urge a clear government commitment to finance and implement the necessary reforms to support the NHS sustainably.

Some healthcare professionals did express very detailed support for more funding specifically dedicated for primary care services, suggesting that this could also serve as a catalyst for more responsible use of taxpayer funds, as indicated by Dr Peter Weeks’ post on X (which reached 24,761 impressions). 

HCPs’ reaction to the 2024 budget – opportunities for more sustainable NHS services.

On 30th of October 2024, Rachel Reeves, the first woman to serve as Chancellor of the Exchequer, made history by delivering the budget in which she promised that under a Labour government, “there would be no return to austerity.” In the UK, healthcare professionals (HCPs) quickly took to social media to react to the latest announcements. Read more about this in our analysis of HCP online reactions to the 2024 UK Budget.

Healthcare in the digital age: the emergent strategic role of social media for healthcare professionals 

Since Lord Darzi’s 2008 report, social media has transformed from a personal networking tool to an essential platform for professional engagement and knowledge sharing among healthcare professionals. In recent years, it has become a vital space for advocacy, peer support, as well as professional and public health education. Several studies indicate that healthcare professionals increasingly leverage platforms like Twitter, LinkedIn, and specialised forums to discuss policy, share clinical insights, and collaborate across disciplines, reaching audiences that extend beyond traditional professional networks (see for example: Ventola, 2014; Gagnon & Sabus, 2020). 

Notably, this digital shift has empowered practitioners to respond swiftly to reports and reforms, as seen with the 2024 Darzi report, where healthcare professionals voiced concerns and endorsements in real-time, amplifying their impact on public discourse. The rise of social media in healthcare has not only strengthened peer connections but has also given healthcare professionals a voice in shaping the very systems they work within, demonstrating the powerful intersection of digital communication and health advocacy (for more information see: Grajales et al., 2014; Surani et al., 2020).

Key reflections

In reflecting on the NHS’s evolution since Lord Darzi’s first report 16 years ago, it’s clear that while significant strides have been made in areas like improved cancer detection and reductions in type II diabetes risks and innovative breakthroughs in terms of genomic testing for certain brain cancers, critical challenges persist. The 2024 report underscores the need for a renewed commitment to preventative care, equitable resource allocation, and digital transformation—all essential to sustaining a resilient healthcare system. 

The growing role of social media has given healthcare professionals a powerful voice in helping to shape health policy as well as public opinion, marking a potential shift in how reforms are discussed and driven forward. The UK Government has partly acknowledged the power of social media listening by inviting people to take part in shaping the future of the NHS in England through digital engagement, encouraging everyone to help shape the future of the NHS. 

As the NHS faces an increasingly complex future, there is an increased emphasis on the urgency of aligning resources with emerging healthcare demands, empowering health and care professionals, and ensuring that reforms are more than policy ambitions but grounded, actionable realities.The NHS has been there for the people of the UK since its inception in 1948, free at the point of need. It has continued to reinvent itself over the last three quarters of a century; to continue to do so it will have to make the most of the opportunities provided in the 21st century.

 

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Meet the Author

Bernard Groen

Bernard has worked in the NHS for nearly 15 years, culminating in a national role as Head of Data Management at NHS England/HEE. Additionally, Bernard worked at Accenture as Consulting Manager leading several large projects across a variety of public sector organisations. Bernard holds a doctoral degree and is a visiting research fellow at Durham University, and an associate professorship at UNICAF University.

Bernard loves spending time outdoors with family hiking, or on a road bike - going fast!