NHS should ‘reform or die’, says Keir Starmer, as he vows big overhaul

Sir Keir Starmer will warn tomorrow that the NHS must ‘reform or die’ as he sets out plans for the ‘biggest reimagining’ of the service since its birth.

The Prime Minister will pledge to cut waiting times and improve access in a bid to tackle the nation’s ill health and get sick people back to work.

It is expected to involve shifting billions of pounds of funding from inefficient hospitals to community care, with a new focus on preventing people getting unwell in the first place.

The radical overhaul comes after a damning new report by Lord Darzi, a pioneering surgeon and former Labour health minister, concluded the NHS is in a ‘critical condition’.

Health Secretary Wes Streeting commissioned the rapid review, which was conducted in just nine weeks and will underpin the Government’s 10-year-plan for reform.

The Tories last night accused Mr Streeting of ‘trying to chase headlines while laying the groundwork for tax rises at the Budget’.

And health experts said the Government must now set out a plan explaining how it will respond to the review.

Lord Darzi, who now sits as an independent peer, said he was ‘shocked’ by the scale of the failings he unearthed.

His 142-page report reveals waits for routine care and A&E have got longer, people have got sicker, and progress in tackling some major conditions has stalled.

Meanwhile, the NHS is bogged down in bureaucracy and has become less productive with the money it receives, it adds.

Responding to the report at the King’s Fund think-tank in London, Sir Keir will say: ‘What we need is the courage to deliver long-term reform – major surgery not sticking plaster solutions.

‘The NHS is at a fork in the road, and we have a choice about how it should meet these rising demands.

‘Raise taxes on working people to meet the ever-higher costs of an ageing population – or reform to secure its future.

‘We know working people can’t afford to pay more, so it’s reform or die.’

 

 

Sir Keir will pledge to work on three fundamental areas of reform to make the NHS fit for the future.

He will say: ‘This Government is working at pace to build a 10-year plan. Something so different from anything that has come before.

‘Instead of the top-down approach of the past, this plan is going to have the fingerprints of NHS staff and patients all over it.

‘And as we build it together, I want to frame this plan around three big shifts – first, moving from an analogue to a digital NHS. A tomorrow service, not just a today service.

‘Second, we’ve got to shift more care from hospitals to communities… And third, we’ve got to be much bolder in moving from sickness to prevention.’

Lord Darzi’s report highlights a lack of investment in new buildings, scanners and technology – all of which have hampered productivity.

He stresses the country ‘cannot afford not to have the NHS, so it is imperative that we turn the situation around’, adding that the health service ‘is in critical condition, but its vital signs are strong’.

Lord Darzi adds: ‘Although I have worked in the NHS for more than 30 years, I have been shocked by what I have found during this investigation – not just in the health service but in the state of the nation’s health.

‘We want to deliver high quality care for all but far too many people are waiting for too long and in too many clinical areas, quality of care has gone backwards.

‘My colleagues in the NHS are working harder than ever but our productivity has fallen.

‘We get caught up frantically trying to find beds that have been axed or using IT that is outdated or trying to work out how to get things done because operational processes are overwhelmed.

‘It sucks the joy from our work – we became clinicians to help patients get better, not to go into battle with a broken system.

‘We need to rebalance the system towards care in the community rather than adding more and more staff to hospitals.’

In a politically-charged attack, Lord Darzi criticises decision-making under the Conservatives and the coalition government, including the impact of austerity and the reorganisation of the NHS under Andrew Lansley in 2012.

He continues: ‘In the last 15 years, the NHS was hit by three shocks – austerity and starvation of investment, confusion caused by top-down reorganisation, and then the pandemic which came with resilience at an all-time low.

‘Two out of three of those shocks were choices made in Westminster.’

The review focuses on the NHS but describes the state of social care as ‘dire’, with underfunding placing an added burden on the health service and families.

In his speech today (THU), Sir Keir will point the finger of blame for the current state of the NHS at the Tories, saying it is ‘unforgivable’.

He will say: ‘People have every right to be angry. It’s not just because the NHS is so personal to all of us – it’s because some of these failings are life and death.

‘Take the waiting times in A&E. That’s not just a source of fear and anxiety – it’s leading to avoidable deaths.

‘People’s loved ones who could have been saved. Doctors and nurses whose whole vocation is to save them – hampered from doing so. It’s devastating.’

Sir Keir will note that there are 2.8 million people economically inactive due to long-term sickness, and more than half of those on the current waiting lists for inpatient treatment are working-age adults.

‘Getting people back to health and work will not only reduce the costs on the NHS, it will drive economic growth – in turn creating more tax receipts to fund public services,’ he will add.

Former Tory health secretary Victoria Atkins has written to Mr Streeting, outlining how the Conservatives were already working to improve outcomes for patients.

Her letter criticises the Darzi review for only focusing on England, highlighting the NHS performs worse in Wales, which has been run by Labour for 25 years.

And she adds: ‘We can only understand your actions as trying to chase headlines while laying the groundwork for tax rises at the Budget.’

Health policy experts welcomed the review but said the Government must now deliver on its findings.

Dr Jennifer Dixon, chief executive of the Health Foundation think-tank, said: ‘The question now is what the government does in response.’

Dean Rogers, director of industrial strategy for the Society of Radiographers, said: ‘The three pillars outlined by the prime minister are only aspirations at this stage. We need a plan showing us how to get there.’

Mr Streeting said he had asked Lord Darzi to ‘tell hard truths about the state of the NHS’ and now vowed to turn the service around.

He added: ‘While the NHS is broken, it’s not beaten. We will turn the NHS around so it is there for you when you need it, once again.’

Lord Darzi’s report highlights a series of NHS failings in recent years

• The health of the nation has deteriorated, with more years spent in ill-health. Factors affecting health, such as poor quality housing, low income and insecure employment, ‘have moved in the wrong direction over the past 15 years’. 
• There has been a ‘surge’ in multiple long-term conditions, including a rise in poor mental health among children and young people. Fewer children get their vaccines and fewer adults now participate in things such as breast cancer screening. 
• Waiting times targets are being missed across the board, including for surgery, cancer care, A&E and mental health services. The overall NHS waiting list stands at 7.6 million. 
• People are struggling to see their GP. The number of fully qualified GPs relative to the population is falling, waiting times are rising and patient satisfaction is at a record low. 
• Cancer care still lags behind other countries and cancer death rates are higher than in other countries. 
• Progress in cutting death rates from heart disease has stalled while rapid access to treatment has deteriorated. 
• At the start of 2024, 2.8 million people were economically inactive due to long-term sickness, with most of the rise since the pandemic down to mental health conditions. 
• Raids on capital budgets have left the NHS with crumbling buildings and too many outdated scanners, and parts of the NHS are ‘yet to enter the digital era’. 
• The NHS’s resilience was already ‘at a low ebb’ when it entered the pandemic, owing to a ‘decade of austerity’, high bed occupancy rates and fewer doctors, nurses, beds and capital assets than most other high-income health systems. 
• Regulatory-type organisations now employ some 7,000 staff, or 35 per NHS provider trust, having doubled in size over the past 20 years.