Workers' Weekly On-Line
Volume 54 Number 26, October 20, 2024 ARCHIVE HOME JBCENTRE SUBSCRIBE

Lord Darzi Report into the NHS, 2024

Sorry History of "Reform" of the NHS

In 2007, the then Labour government called in Professor Darzi to do a review of the NHS. Workers Weekly [1] commented then: "Before considering this review, it is worth reflecting on the [Labour] government's 10-year NHS Plan published on July 1, 2000. This plan promised by 2010 investment in the NHS to create 7,000 extra beds in hospitals and intermediate care with over 100 new hospitals by 2010 and 500 new one-stop primary care centres, over 3,000 GP premises modernised and 250 new scanners, clean wards - overseen by "modern matrons" - and better hospital food, modern IT systems in every hospital and GP surgery, and investment in staff with 7,500 more consultants and 2,000 more GPs, 20,000 extra nurses and 6,500 extra therapists, 1,000 more medical school places childcare support for NHS staff with 100 on-site nurseries." The article continued "that one could be forgiven for at least hoping that the government had called in Professor Darzi to ensure that this 10-year NHS p lan that was supposed to be the centrepiece of its health policy was being implemented". Darzi did not do that.

Darzi was called in in 2007 to promote investment in community care at the expense of shedding thousands of nurses, doctors and other health workers, either through direct redundancies or through not replacing vacancies as then government imposed its "deficit" financing on the NHS to force the NHS to "balance its books". A plan by the NHS Health Authorities to close around 50 District General Hospitals was also central to this. In fact, this is why Professor Darzi (now Lord Darzi) was picked to do the review in 2007 in the first place. He had already set out his blueprint for London's future healthcare in a report A Framework for Action which continued with the government's agenda of claiming to provide more care in community services as an excuse to close many London hospitals.

Today, the situation is very similar although the NHS has been further wrecked by successive governments since then, not only with the further closure of hospital services and mental health services but also with the huge loss of GP numbers and community health and mental health services. Boris Johnson's government infamously lied to the people by promising to build 40 new hospitals and employ 50,000 new nurses in their previous election manifesto whilst doing the opposite in government by continually deferring these plans. Now the new Labour government has brought in Darzi to make sure that this direction of investment in the NHS for 40 new hospitals and the training of 50,000 nurses is not only dead in the water but reversed. That is the aim. Already, the government has put the new hospital building programme under "review" stopping progress on hospital programmes while a "realistic" and "costed" timeline is worked out. The new Whipps Cross hospital is an example of a programme that was already underway and now is halted.

On September 16, speaking about the Labour government's plans for the NHS and what the aim of the Darzi report is, Dr Bob Gill, a General Practitioner and long-standing NHS campaigner, said in an interview that this is about "replacing hi-quality care in hospital settings with a substitute service run in the community by the private sector with untested technology and without the necessary workforce to back it up. Community services are barely functioning at the moment and they want to transfer more care into non existent services."

In an AGM of South Tyneside and Sunderland Foundation Trust on September 24, the Save South Tyneside Hospital Campaign (SSTHC) representative commented in a discussion with the CEO on the Darzi plan that "our health services are already in the community of South Tyneside and Sunderland with our hospitals" and that services "in the community" were now almost non existent. He said that SSTHC had objections to shifting investment away from hospitals and into new private firms operating in the community to fill the vacuum when "those services still exist in our communities in our local hospitals". This, he said, was very concerning as it would reduce real existing specialised community services in favour of privately provided hubs.

In the discussions that are now taking place in the 42 NHS Integrated Care Boards in England (ICBs) [2], the "three big shifts" of "a move from hospital to community care; from analogue to digital; and from treating sickness to preventing it", which was announced by Streeting and backed up by the Darzi report, are already being dubbed as the new "left shift" direction for the NHS. But this is to be achieved "within the financial constraints". This is causing huge concern as already the ICB agendas are filled with items trying to recover vital hospital acute, ambulance, mental health, dental and community services which even government and Darzi describe as in "critical condition", but everything must be "within the financial constraints" placed on them by government policy.

If one looks at these discussion of the ICBs, whilst they admit there are serious and worsening inequalities in society as well as worsening child poverty they have no solutions, no power to change this direction of the society and its economy. For example, the ICB North East and North Cumbria, an ICB covering the largest area in the country, responded to Darzi's report by saying that "we also need to seize the opportunity to build on our partnership working with Local Authorities, Voluntary Community and Social Enterprises and Combined Authorities to enable healthcare to contribute to the economic growth of our region". The ICB needs "to play a part in addressing child poverty and the evidence-based impact it has on young people's health outcomes will be critical for us." What these statements do not highlight is the reality and the anti-social direction that the government is implementing in the NHS and society. This Labour government is one that cannot even remove the Conservative "two child cap" on child benefit that has had serious consequences on child poverty, but is expecting ICBs to pick up the bill from existing resources to deal with child poverty and free school meals as increasing cuts also bite into local authority budgets. Further, the talk about shifting from treating sickness to preventing it has raised similar concerns among health workers and their communities. What Darzi is saying is not about healthy food, good housing as a right for people, and good preventative services, but is about shifting funds away from providing vital health care in our NHS to IT companies and big pharma for more drug like "prevention" whilst cutting budgets to health care further. If this is allowed to happen it will deepen further the crisis in the NHS not prevent it.


Notes
1. Professor Darzi's Review of the NHS: "Our NHS, Our Future" - Workers' Weekly, September 25 2007
https://www.rcpbml.org.uk/wdie-07/d07-053.htm
2. Integrated Care Boards (ICBs) are the new government appointed Boards for commissioning NHS contracts along with Integrated Care Partnerships (ICPs) and other sub-committees that place contracts in the public and private sector for NHS services. The ICBs were set up by the previous government in 2022 with the Health and Social Care Act 2022 to replace their previous local Clinical Commissioning Groups (CCGs) setup by the Coalition government with the Health and Social Care Act 2012. ICBs have no statutory duty even to make their decisions in public, and the Act tasked them with "overcoming the bureaucracy" of the regulatory systems of "procurement and market bureaucracy". This has meant that whilst some of the Board meetings are held in public how services are commissioned no longer take place even "with an extensive procurement procedure" of the previous CCGs that at least were more visible to the public.


Link to Full Issue of Workers' Weekly

RCPB(ML) Home Page

Workers' Weekly Online Archive