An NHS on its knees means A&E waits are deadlier than going to war

Long delays in treatment are likely to be causing an additional 14,000 deaths a year

The National Health Service is in serious trouble, and the stark conclusion of a 242-page investigation by Lord Darzi is perhaps summed up best by one piece of data.
Fifteen years ago, patients turning up at A&E could expect to find 39 people ahead of them in the queue – a prospect few would relish. Now the number is beyond 100, the latest figures show.
When Labour won the election, Wes Streeting, the Health Secretary, declared the NHS “broken”. 
A week later, he commissioned Lord Darzi, a leading surgeon and former health minister, to carry out an independent investigation into the state of the health service.
Lord Darzi was a Labour minister under Gordon Brown, from 2007 to 2009. His investigation – which will trigger fierce political rows – covers the period that followed, after the coalition government was formed.
More than 300 pieces of analysis were commissioned, with evidence collected from 227 organisations,
Some of the simple facts are the starkest. In 2010, 94 per cent of A&E patients were seen within four hours. By May this year that figure had dropped to just over 60 per cent, and nearly 10 per cent of all patients are now waiting for 12 hours or more.
The research goes further. “According to the Royal College of Emergency Medicine, these long waits are likely to be causing an additional 14,000 deaths a year – more than double all British Armed Forces’ combat deaths since the health service was founded in 1948,” it says.
Lord Darzi concludes: “A&E is an awful state.”
Even before the report was published, it was stoking political arguments.
Victoria Atkins, the shadow health secretary, said on Sunday that the findings would provide “cover for the Labour Party to raise our taxes in the budget in October”.
In fact, Lord Darzi’s report tells a more nuanced story, warning that far too much money has been poured into hospitals without any commensurate rise in patients receiving help. “The NHS has more resources than ever before, even if there is an urgent need to boost productivity,” he writes.
Lord Darzi found that hospital staff numbers had risen by 17 per cent since 2019. Despite this significant flow of resources into hospitals, output had not risen at nearly the same rate. “The result is that a large productivity gap has opened up,” he warns.
Overall, hospital productivity is at least 11.4 per cent lower than in 2019 – a key obstacle in clearing backlogs. As a result, the number of appointments, operations and procedures has failed to keep pace.
“Looking across clinical workforce crude productivity metrics, a pattern is readily apparent – productivity has fallen,” the report says.
Surgical activity is down by 15 per cent, while the number of outpatient appointments per consultant has fallen 10 per cent. Over the same period, the number of clinicians for each bed has increased by 13 per cent, while the number of  A&E attendances per clinician is down 23 per cent.
Lord Darzi suggests that several factors, including a lack of capital funding, have left the NHS unable to perform effectively. His report describes a “shortfall of £37 billion of capital investment”, saying this is what the service would have spent if it had matched peer countries on equipment, technology and equipment.
“Instead, we have crumbling buildings, mental health patients being accommodated in Victorian-era cells infested with vermin, with 17 men sharing two showers, and parts of the NHS operating in decrepit Portacabins,” the report says.
It points out that the 2010s were the most austere decade since the NHS was founded, with spending growing at around one per cent in real terms. The “starvation” of capital funding means staff are wasting vast amounts of time just to achieve the basics, such as phoning around wards in search of a bed.
“With the NHS budget at £165 billion this year, the health service’s productivity is vital for national prosperity,” says the report. “Moreover, the NHS must rebuild its capacity to get more people off waiting lists and back into work.”
On Thursday, the Prime Minister is expected to say that the public cannot afford to pay more for the NHS and that the service faces a “fork in the road” about how to meet the rising demands on it.
Speaking at an event in central London, Sir Keir Starmer will say: “Raise taxes on working people to meet the ever-higher costs of an ageing population – or reform to secure its [the NHS’s] future. We know working people can’t afford to pay more, so it’s reform or die.”
Lord Darzi’s report says far more of the NHS budget should be shifted out of hospitals entirely and used to fund GP and community services to keep people well for longer. This is a pledge Mr Streeting has already made, but has yet to flesh out.
Before Labour won the election, Mr Streeting told the Telegraph that Labour would divert billions of pounds from hospitals in an attempt to save “the front door” of the NHS.
Lord Darzi, a pioneering surgeon who was given the nickname Robo Doc for spearheading the use of keyhole surgery and robotics in operating theatres, also rails against the failure of the health service to embrace technology. He describes the last decade as “a missed opportunity to prepare the NHS for the future”.
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The peer also highlights the “dire state of social care” in leaving thousands of patients in hospital without medical need, resulting in the system grinding to a  halt.
He takes shot at the Tories for the 2012 reorganisation of the NHS, which he describes as “a calamity without international precedent”, saying it distracted the management of the health service. The report suggests that the combination of austerity and the 2012 reforms left Britain in a weakened state when the pandemic hit, further damaging productivity.
“The NHS delayed, cancelled or postponed far more routine care during the pandemic than any comparable health system. Between 2019 and 2020, hip replacements in the UK fell by 46 per cent compared to the OECD average of 13 per cent,” says the report.
“Knee replacements crashed a staggering 68 per cent compared to an average fall of 20 per cent. Across the board, the number of discharges from UK hospitals fell by 18 per cent between 2019 and 2020 – the biggest drop across comparable countries.
“The state of the NHS today cannot be understood without recognising quite how much care was cancelled, discontinued or postponed during the pandemic.”
Lord Darzi said that despite working in the NHS for more than 30 years, he had been shocked by what he found during his investigation.
Britain has long lagged behind other nations for cancer survival, despite repeated pledges to tackle failings that cut lives short. However, the investigation found that “no progress whatsoever” was made in improving early diagnosis of cancer between 2013 and 2021, with a slight improvement since.
Death rates from cancer are “substantially higher” in the UK than other western European and Nordic countries, as well as the US, Canada, Australia and New Zealand.
Britain’s survival rates lag behind countries such as Norway, Sweden, and Denmark on all major cancers, the report says, as well as European and other English-speaking countries for lung, breast and colon cancers.
An increase in cancer mortality since Covid is forecast to set the UK’s death rate back by more than a decade, while other English-speaking countries were hardly impacted by the pandemic.
Under NHS targets, patients with suspected cancer should start treatment within 62 days of an urgent referral. In fact, this happens in less than two in three cases, with a target of 85 per cent unmet since 2015.
“How long people wait, and the quality of treatment, are at the heart of the social contract between the NHS and the people,” says the report. “The NHS has not been able to meet the most important promises made to the people since 2015.”
A record 2.8 million people are economically inactive because of long-term sickness. That is an 800,000 increase on pre-pandemic levels, with most of the rise accounted for by mental health conditions, Lord Darzi notes.
A significant rise in musculoskeletal conditions, such as back pain, is also pushing increasing numbers out of the workplace, with young people most adversely affected.
Long-term sickness absence rates for people aged 16 to 34 with musculoskeletal conditions have reached 16.4 per cent, up from 9.7 per cent in 2015.
The latest figures show that around 6.4 million people are on waiting lists in England – of these, more than half are working age adults.
In his first speech as Health Secretary in July, Mr Streeting said the NHS must deliver the Treasury “billions of pounds of economic growth”.
But the report warns that the NHS can only contribute to national prosperity if it gets patients off waiting lists. “Having more people in work grows the economy and creates more tax receipts to fund public services,” it says. “There is therefore a virtuous circle if the NHS can help more people back into work.”