In July 2024, the Secretary of State for Health and Social Care commissioned Lord Darzi to conduct an independent investigation of NHS England ahead of a forthcoming 10-year health plan. The investigation has found the service to be in a “critical condition”, with long wait times ‘likely’ to be causing thousands of excess deaths each year.
According to the Royal College of Emergency Medicine (RCEM), long waiting times “are likely to be causing an additional 14,000 more deaths a year” – more than double all British Armed Forces’ combat deaths since the health service was founded in 1948.
It comes just weeks after the government unveiled its budget (30 October 2024), which failed to include any additional support to mitigate a winter crisis – which many A&E departments are predicted to face.
14,000 associated excess deaths related to waits of 12 hours or longer
The RCEM has calculated there will be one additional death for every 72 patients that experience an 8–12-hour wait prior to their admission. As a result, the RCEM estimates that there were 14,000 associated excess deaths related to waits of 12 hours or longer in 2023 – more than 268 a week.
President of the Royal College of Emergency Medicine, Dr Adrian Boyle, stated: “Our patients, each one vulnerable and sick in need of care and comfort, each one someone’s mum, dad, gran or grandad, condemned to degrading and dehumanising so called ‘corridor care’. This euphemism, in reality, means people being stranded for hours on trolleys or chairs.”
Boyle continued: “And as every hour ticks by, the associated risk of those people dying as a result increases. Just last month, 162,931 people in England alone endured stays of 12+ in an A&E department.”
Independent investigation findings released
The investigation found that waiting time targets are being missed across the board, from access to GP appointments to A&E departments to routine surgery and treatments for cancer and cardiac services.
In England there are 16% fewer fully qualified GPs than other high income countries (relative to population) with “huge and unwarranted variations” in the number of patients per GP. According to the report, shortages are “particularly acute” in deprived communities.
There has also been a surge in multiple long-term conditions, particularly among children and young people, in mental health needs. The report stated that fewer children are getting the immunisations they need to protect their health and fewer adults are participating in some of the key screening programmes, such as for breast cancer.
Waiting time for cancer patients has not been met since 2015
In England, there are three types of A&E department. Type 1 are what most people think of as A&E -they are major departments and able to deal with the full range of emergencies. Type 2 are for specific conditions such as dental or ophthalmology and type 3 are for minor injuries and illnesses.
In 2010, 94% of people attending a type 1 or type 2 A&E were seen within 4 hours; by May 2024 that figure had dropped to just over 60% (and for all three types of A&E combined, performance is now at 74%). More than 100,000 infants waited more than 6 hours last year, and nearly 10% of all patients are now waiting for 12 hours or more.
The investigation also found that the 62-day target for referral to first treatment for cancer patients has not been met since 2015. Additionally, in May 2024 more than 30% of patients waited longer than 31 days for radiotherapy.
NHS budget is “not being spent where it should be”
While growth in hospital staff numbers has increased since the pandemic, rising 17% between 2019-2023 – the number of appointments, operations and procedures has not. According to the investigations findings, the key reason for this is that patients no longer pass through hospitals efficiently.
This has led to 13% of NHS beds being occupied by people waiting for social care support or care in more appropriate settings. This has resulted in 7% fewer daily outpatient appointments for each consultant, 12% less surgical activity for each surgeon, and 18% less activity for each clinician working in emergency medicine.
Addressing the issue, Lord Darzi stated: “Too many people end up in hospital, because too little is spent in the community. Many people will have experienced congested A&E departments themselves. If you had arrived at a typical A&E on a typical evening in 2009, there would have been just under 40 people ahead of you in the queue. By 2024, that had swelled to more than 100 people. This is because we have underinvested in the community”.
Darzi continued: “Since at least 2006, and arguably for much longer, successive governments have promised to shift care away from hospitals and into the community. In practice, the reverse has happened. Both hospital expenditure and hospital staffing numbers have grown faster than the other parts of the NHS, while numbers in some of the key out-of-hospital components have declined. Between 2006 and 2022, the share of the NHS budget spent on hospitals increased from 47% to 58%.”
This systemic problem has led to patients having ‘poorer experiences’ and delays in care.
Mental health waiting list the size of Leicester
As of June 2024, more than one million people were waiting for community services, including more than 50,000 people who had been waiting for over a year, 80% being children and young people. By April 2024, about one million people were waiting for mental health services.
Currently, 345,000 people are waiting more than a year for first contact with mental health services – more than the entire population of Leicester. Of those referrals,109,000 were under 18.
Addressing the issue, Chief Executive of Mind, Dr Sarah Hughes, said: “The Budget and the Mental Health Bill showed glimmers of promise but did not deliver change on the scale we need. The nation’s mental health cannot wait. If we do not take action now, we will be staring at a very bleak future in the face, knowing we could have done something big. This government has a huge mandate, so we ask them to be brave, and we will do everything we can to help.”
Rebuilding public trust
Public satisfaction of the NHS stood at a record high in 2009, flash forward to the present day, and it is the lowest ever recorded. But what happened during those years to result in such a change? Among austerity and Covid-19 is the matter of a shortfall in capital investment in the 2010s, which could have made a profound impact on the service.
According to the investigation, there is a shortfall of £37 billion of capital investment that would have been invested if the NHS had matched peer countries’ levels of capital investment in the 2010s.
The amount would have paid for the 40 new hospitals that were pledged by the previous government, and would have even paid for the refurbishment of “every GP practice in the country”.
“We cannot afford not to have the NHS”
Meanwhile, some NHS services in England are quite literally crumbling. The investigation found that “crumbling” infrastructure impacted services at 13 hospitals a day between 2022-2023. Meanwhile, the cost of repairing the NHS buildings now stands at more than £11.6 billion.
Lord Darzi stated: “ – We have crumbling buildings, mental health patients being accommodated in Victoria-era cells infested with vermin with 17 men sharing two showers, and parts of the NHS operating in decrepit portacabins. Twenty per cent of the primary care estate predates the founding of the health service in 1948.”
While the investigation has highlighted serious concerns about NHS England, it also emphasised the importance of a free, accessible healthcare service and praised staff for their vital work.
Addressing privatisation, Darzi stated: “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 – It is not a question, therefore, of whether we can afford the NHS. Rather, we cannot afford not to have the NHS, so it is imperative that we turn the situation around.”
