Key Findings of the Darzi Review 

The Darzi Review paints a sobering picture of the NHS's current state, highlighting several critical issues: 

• Deteriorating national health and widening health inequalities, with stark disparities in life expectancy and health outcomes between deprived and affluent areas 

• Significant increase in waiting lists and times, including in hospital services such as planned care and A&E, and also noting "hidden waits" for community and mental health services

• Decreased productivity in hospitals and underfunding of community care, leading to an imbalance in resource allocation 

• Insufficient capital investment, resulting in deteriorating infrastructure and lack of digital transformation 

• Workforce challenges, including uneven growth and staff disempowerment 

• Critical areas of concern in cancer care, mental health services, cardiovascular disease, and maternity care 

Despite these challenges, the review also emphasised the NHS's resilience and the dedication of its staff. It proposed several areas for the Government's 10-year plan to reform the NHS to look at, including staff re-engagement, shifting care closer to home, improving hospital efficiency, and leveraging technology. 

The PSC's Submission: Addressing Urgent & Emergency Care "Crowding Out" other services

One of the areas that Lord Darzi focussed on was the allocation of NHS funding, revealing that the share of NHS spending on hospitals increased from 47% in 2006 to 58% in 2021. This trend was counter to the NHS's stated goal of shifting care closer to home. 

This area builds, in part, on our submission to the review, which provided evidence that Urgent & Emergency Care (UEC) is "crowding out" other services. Our analysis showed a year-on-year reduction in UEC productivity metrics, particularly in A&E departments and indicated that this decline was due to systemic issues, not down to staff performance.

Key points from our submission included: 

• UEC Expenditure Growth: Since 2010, NHS expenditure on UEC has grown rapidly, overtaking Planned Care in 2017/18. This trend has continued and was accelerated during the pandemic, with UEC now absorbing a greater proportion of the NHS budget. 

• Impact on Other Services: The disproportionate growth in UEC is crowding out funding for planned care, diagnostics, primary care, and community care. This imbalance threatens the NHS's ability to deliver comprehensive healthcare services. 

• Productivity Challenges: Our analysis showed a year-on-year reduction in UEC productivity metrics, particularly in A&E departments and indicated that this decline was largely due to systemic issues, rather than staff performance. 

• Root Causes: We identified several factors contributing to declining UEC productivity, including reduced patient flow, increased demand from an ageing population, and inadequate funding for social care and intermediate care services. 

Much is already known about the combination of environmental conditions and levers that are required to deliver productivity improvements in the end-to-end UEC pathways. These levers include:

1. Technology: Leveraging Medical Technology and Digital Technology innovations
2. Process: Optimising pathways, & procedures to enhance efficiency and reduce waste
3. Workforce: Optimising human resources and leveraging the skills and roles of healthcare professionals

At The PSC, we remain committed to supporting the NHS in its journey of improvement. If you would like to discuss our findings on UEC "crowding out" or how we can support your organisation in grappling with the challenges raised by Lord Darzi's report, please get in touch at hello@thepsc.co.uk.