England’s health service is in deep trouble, report finds

Staff work at the Queen’s Hospital emergency room, in Romford, England, on March 20, 2023. A government-commissioned review into the National Health Service laid bare the challenge Prime Minister Keir Starmer faces after years of underinvestment. (Andrew Testa/The New York Times)

By Stephen Castle

England’s National Health Service, one of the country’s most revered institutions, is in “critical” condition, according to a government-commissioned report that cited long waits for treatment, crumbling hospitals, mental health patients in “vermin-infested cells” and far fewer MRI scanners than in comparable countries.

The hard-hitting review, published late Wednesday, was commissioned by Britain’s new prime minister, Keir Starmer, after he won the general election. The dire state of the NHS was a key reason many people voted for his Labour Party in July, according to polls.

But the report underscores the scale of the challenge the government faces to revive a health care system that is in a spiral of decline after years of underinvestment and administrative meddling and is still suffering the aftershocks of the pandemic.

Starmer said in comments his office released Wednesday that he was working on a 10-year plan that could amount to the “biggest reimagining of our NHS” since its creation in 1948.

The report, written by Ara Darzi, a surgeon and member of the House of Lords, said that during the 2010s, when a Conservative-led government embarked on a stringent austerity program, the NHS was “starved of capital,” leading it to fall behind other countries in terms of investing in diagnostic equipment, technology and buildings.

His findings will not surprise Britons, whose satisfaction in the health service is “at its lowest ever,” the report said, having peaked in 2009. Still, even Darzi, who has spent three decades in the NHS, said that he was “shocked” by what he discovered and laid the blame for the problems on successive Conservative-led governments that held power for 14 years.

Starmer described the findings as “unforgivable” in comments released before a speech Thursday, in which he plans to argue that the health service must “reform or die.”

“People have every right to be angry,” he said. “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.”

Paid for through general taxation and payroll deductions, medical treatment in Britain is delivered to patients without money changing hands, with a few exceptions such as dentistry and prescription medication.

The NHS was created after World War II by a Labour government that aimed to make health care available to everyone, regardless of income or wealth. It grew so popular that Nigel Lawson, a former chancellor of the Exchequer, described it as “the closest thing the English have to a religion.”

In his speech Thursday, Starmer is expected to prepare Britons for a long wait before their health care system is restored. That echoes a warning he made last month that, because of the scale of the challenge he inherited in restoring the economy and public services, circumstances “will get worse before they get better.”

Starmer said his government would focus on digitizing the NHS, moving care from overburdened hospitals to other settings in the community and investing in preventive health care.

Darzi’s report pointed out that the failure to invest in the NHS had coincided with rising demand because of Britain’s aging population and surging levels of long-term sickness.

Among the consequences: Long waits for treatment in emergency rooms are estimated to have caused an additional 14,000 deaths each year. And outcomes for cancer patients lag behind those of comparable countries, with “appreciably higher” mortality rates in Britain than in many European nations, the report said.

Darzi was particularly damning of the major restructuring of the NHS in 2012 by Conservative Health Secretary Andrew Lansley, which the report described as “a calamity without international precedent.”

The health service’s capacity was “degraded by disastrous management reforms,” he wrote, while “the trust and good will of many frontline staff has been lost.”

The changes were intended to encourage more competition in health provision but were criticized for creating a fragmented and complex structure.

Jennifer Dixon, CEO of the Health Foundation, a charity, said in a statement that the report pointed to some “obvious priorities” for change and argued, “The NHS is weakened but not broken — and staff can recover services if they are given the resources to make it happen.”

Darzi, who was once a Labour Party member but left because of its handling of antisemitism allegations under former leader Jeremy Corbyn, pointed to the inadequacy of government spending increases for the NHS that, for most of the 2010s, were limited to 1% compared with a decades-long average of 3.4%.

Chronic problems that had built up in the health service over years became acute when COVID-19 hit, and the NHS entered the pandemic with fewer available beds and fewer staff than most other high-income health systems, the report said.

Hospitals delayed, canceled or postponed more routine care during that period than any comparable health system did.

The result was longer waits for treatment. Lines at emergency rooms more than doubled, from an average of just under 40 people on a typical evening in April 2009 to over 100 in April this year.