Fixing a ‘broken’ NHS 

In the last week, the NHS and future health policy has well and truly returned to the fore. Following the publication of the Darzi Review, and Luther’s roundtable with Hugh Pym, Consultant Callum Nimmo reflects on what comes next for the NHS.

Within hours of walking into the Department of Health and Social Care, Wes Streeting had declared the NHS broken, something that only a Labour Secretary of State could do. Nine weeks later, the Darzi Review has set the scale of what would constitute a ‘fix’ very high, pointing to issues in every corner of the creaking health service. The terms of reference of the Review meant that it could not make any policy recommendations, but it did set out set out several ‘key themes’ to improve outcomes, such as empowering patients, engaging staff, driving productivity, and boosting the use of technology. It now falls to the new Government to decide the exact means through which these themes are realised.  

The Darzi Review was published only hours after Luther Pendragon’s roundtable with BBC Health Editor Hugh Pym and it was on the minds of all who attended. The Review, and the NHS 10 Year Plan due to be published in Spring 2025, will form the basis of Labour’s health policy for the rest of the parliament. Health leaders at our event were cognisant that the Government is therefore looking to innovate; In Streeting’s own words, the NHS must “reform or die.”  

August had been quiet in terms of health policy announcements, as the Review was finalised. Now, following its publication and the PM’s speech at the King’s Fund the following day, it is clear that health is going to be at the forefront of the Government’s agenda in the coming months. The Government’s emphatic diagnosis of failure and the new language of a ‘broken’ NHS, suggests we’re at a ‘reset’ moment between the Government and the health service – one where solutions, not more problems, and not necessarily more cash – are needed.  

Attendees at the roundtable were eager to share their solutions. From making the most of clinical skills from professionals across the system, to better use of data, and harnessing the untapped potential of the medtech and life sciences sectors, there are many levers the Government could pull. At Luther, we’re working with a range of organisations to help present their ideas in the most compelling way, adopting the Government’s language and highlighting how a policy aligns with their wider priorities.  

The policies adopted will invariably depend on their financial implications. In his speech on the Darzi Review, Sir Keir Starmer was unequivocal that there will be “no more money without reform,” and the reforms chosen must increase productivity, and therefore, value for money. It’s hard not to see this as a forewarning for difficult decisions – encompassed by the three ‘shifts’ that the Government wishes to oversee (analogue to digital, hospital to community, and sickness to prevention). 

Moving money out of hospitals and into the community, as Starmer hinted at, may create short term pain but bring long term benefits. Preventative policies take a while to create any real savings or improvements. Today’s obesity epidemic won’t be cured by the (much-needed) emphasis on prevention. And weighing down the “broken NHS” is the social care sector, which Darzi described as being in a “dire” state. Without a plan for social care, it is difficult to envisage a lasting ‘fix’ for the NHS. Yet, on social care, Labour has so far remained muted.  

There are two Spending Reviews on the horizon: a one-year settlement to be announced in the Budget in October, and then a comprehensive three-year review to conclude in Spring 2025. These will be when the big calls are made. The timing of the comprehensive spending review will be very close to the anticipated publication of the NHS 10 Year Plan, suggesting that the two processes will be interlinked. There will also likely be much competition from across the system for a better financial settlement. In just about every corner, the issues stem from a lack of investment – in capital projects, workforce, technology, the list goes on.  

We are now in a crucial moment for health and care policy. The Darzi Review has affirmed the “broken NHS” hypothesis, and while there may be agreement on the concepts that could underpin the fix, there is a lot to be done to turn those concepts into practical public policy.   

The Government recognises that health and care cannot keep taking an ever-increasing share of public spending while outcomes and public satisfaction get worse. Identifying and implementing policies that drive efficiency, improve outcomes, and are politically workable is a difficult three-way trade off. When vying for the Government’s attention, those with something to offer must reflect the Government’s language, align to their priorities, and show the trade-offs involved are worth it. Perhaps that famous phrase adopted by a previous Prime Minister after a landslide victory has never been more true: don’t bring me problems, bring me solutions. 

We’re helping a range of health and care organisations do exactly that. We work with clients from across the system, and have a deep, holistic understanding of health policy and the challenges involved.

How can we help you?

Contact the Luther Pendragon team at enquiries@luther.co.uk