NHS must 'reform or die' warns Starmer after report finds health service is in 'critical condition'

The NHS must “reform or die”, prime minister Keir Starmer has warned, after a damning new report identified sweeping failings in the health service.

The independent investigation – commissioned by the new government and carried out over the last nine weeks by peer and surgeon Lord Darzi – warns that the NHS is in “critical condition” and “serious trouble.”

It highlights crumbling infrastructure, staff shortages, and avoidable deaths in the NHS’s struggling emergency departments – and criticises previous austerity measures that have worsened the system’s ability to cope with rising demand.

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“The 2010s were the most austere decade since the NHS was founded, with spending growing at around 1% in real terms,” the report warns – well short of the 3% recommended by independent health organisations.

Speaking this morning, Starmer described the 2010s as a “lost decade” for the health service.

“People have every right to be angry. It left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow,” he said.

The “awful state” of A&E is causing an additional 14,000 more deaths a year, the report warns, with nearly a tenth of all patients waiting 12 hours or more. Meanwhile, the UK has higher cancer mortality rates than other countries, and the number of appointments and procedures has stagnated because “patients no longer flow through hospitals as they should.”

A dearth of capital investment has led to “crumbling buildings”, “parts of the NHS operating in decrepit portacabins,” and mental health patients in “Victoria-era cells infested with vermin”.

Dr Sarah Hughes, chief executive of Mind, described the report’s publication as a “dark day for mental health.”

“How many more reports and inquiries will it take before we see meaningful action to end what is a national scandal?” she said.

Underfunding is not the only cause of these issues. The health of the nation has deteriorated significantly, with 2.8 million people economically inactive due to long-term sickness. “We are becoming a sicker society,” Starmer said.  

The prime minister promised serious reforms of the NHS, pledging a “dramatic reimagining” of the service.

“The NHS is the right model, but it’s not taking advantage of the opportunities in front of it,” said Starmer. “No more money without reform. We have to fix the plumbing before we turn on the taps.”

The government’s 10-year plan for the NHS – which will be published next spring – includes three “big shifts” in its approach.

These include using more technology to create a “digital NHS”, shifting more care out of hospitals and into communities, and moving from treating sickness to focusing on prevention. The government has previously announced plans for a new social care system, reforming how people pay for care.

Speaking to the BBC this morning, health secretary Wes Streeting confirmed that hospitals will receive proportionately less money going forward, with more funding poured into community services instead.

The British Medical Association (BMA) described the report as “sobering” but “unsurprising.”

“Without radical action, the NHS won’t survive,” said professor Philip Banfield, BMA council chair, in a statement, calling on the government to redirect funding to GPs and doctor’s pay.  

The Darzi investigation provides the right diagnosis, said Chris Thomas, head of the IPPR commission on health and prosperity. However, he urged against compromising the NHS’s fundamental funding model.

“Lord Darzi is right that the NHS has been beaten by a pandemic, austerity and misguided reform,” he said. “But he is also right that the NHS’s model is not fundamentally broken – we must not be distracted by rabbit holes like social insurance systems or changed funding models.”

“It is not just the nation’s health that is at stake, but our national economy.”

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