“It’s even worse than we thought!” The Darzi review of the NHS and what it might recommend

Health Secretary Wes Streeting has today announced a “warts and all” review into the state of the NHS led by eminent surgeon and former Labour Health Minister Lord Darzi.

There was chatter before the election about a review of this kind being commissioned. It serves two clear purposes for Streeting and the new Government.

First, it will provide an anchor point for Labour’s narrative of the NHS being ‘broken’. I can already hear Streeting presenting the review to Parliament this autumn saying, “the state of the NHS is even worse than we thought!”.

We all know the NHS is struggling to deliver for patients in many areas, and pulling the evidence together in one place will help Labour to manage public expectations and argue that the problems will take time to fix. Labour has talked about a ten-year programme for renewal, and the expectation is that Streeting’s forthcoming NHS strategy will be a ten-year plan.

This review will give the Government cover to argue that it will take ten years to repair the NHS, as well as providing a weighty political stick with which to beat the Conservatives for years to come.

Second, the review will provide fuel and justification to accelerate the reforms Streeting will propose in his NHS strategy. We should expect recommendations from the review to align with the direction Streeting is taking - and it will be helpful for Streeting to point to reform recommendations from a world respected clinician and argue that his plan is not about tinkering by managers or politicians, but is in line with clinical recommendations in the interests of patients.

Darzi has written NHS Strategies before

Lord Darzi was a Health Minister under the last Labour Government and published two NHS Strategies (an interim and a final report). Despite being over 15 years old they are worth studying for Darzi’s mindset and potential recommendations. Sadly, many of the challenges he identifies are still present in today’s NHS.

There is a clear alignment between his recommendations then and some of the reform narrative Streeting uses today.

Return of the Polyclinic? – three stand out recommendations

Amongst the many recommendations in Lord Darzi’s two previous reports, three things stand out.

• Darzi encouraged a drive for greater health and well-being services in the NHS locally to aid prevention and improve health (not just treat illness).
• He called for greater partnership between the NHS and private and third sector organisations to deliver NHS services.
• Darzi recommended changes to primary care including moves to boost the quality of GP services and, most notably, a flagship policy to create 150 GP-led Health Centres to expand the availability and accessibility of services in the community.

These Polyclinics as they became known were to offer a wide range of services within the community including access to diagnostics, mental health, social care, sexual health and other services in an integrated one-stop-shop. They were trumpeted as being open seven days a week, and in the evenings to make them more convenient for patients both timewise but also in local accessibility to services sometimes only available in hospitals. In the end, few were ever opened.

Streeting has spoken repeatedly of the need to boost the prevention of ill health, improve diagnostics services, partner with non-NHS providers, and increase access to high quality primary care.   

There may be trouble ahead

Whether Streeting proposes a new form of Polyclinic or not, they are a sobering case study in the challenges of reforming the NHS and primary care.

Polyclinics were a major part of NHS policy for Gordon Brown’s Labour Government, yet few were ever opened. Despite being explicitly called “GP-led” health centres, they were strongly opposed by the GP’s themselves - the doctors’ trade union the BMA said they were “unproved, risk undermining care of patients, and threaten the future of general practice.”.

These one-stop-shop community health centres are commonplace in many other countries and there are a number across the NHS – they were just never widely implemented as planned.

If this Government is to shake up primary care and roll out noticeable change Streeting will need the backing of Darzi and others influential figures to fight any opposition from the GPs who often continue to guard their traditional small business way of working. He will also need the media on his side and it is noteworthy that the Sun newspaper today labels the BMA as “militant” regarding its strike action by junior hospital doctors. Of course, money is a great lubricant in NHS change and the promised increase in funding for primary care may well open the path to a solution.

NHS reform is never easy, even for Labour Governments. Streeting will need to fight to deliver his reforms, but he will know that patients are on his side.

This review will strengthen his arm for those battles ahead.