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The recent publication of the Darzi investigation has uncovered sobering findings within the current crisis of the healthcare system. In particular he has highlighted key issues regarding drivers of performance, including capital, Covid-19, patient and staff engagement and management structures and systems – in particular, regarding defining the roles and accountabilities of Integrated Care Boards.
Darzi concludes with a recognition that ‘the system’s vitals’ are still strong and whilst the journey ahead is long, it's not impossible.
The report analyses the entire healthcare system, but this insight will focus on how social care challenges are impacting the NHS, the NHS App not being used to its full capability, how lack of capital investment and financial flows are impacting performance, and how the healthcare service can make better use of technological developments.
Whilst social care has fallen outside of the remit of Darzi’s investigation, the report highlights its significant contribution to the ongoing crisis within the NHS. The impact of austerity on local authorities, and the means tested nature of social care support has placed an increasing demand on secondary care settings, with more people being stuck in hospitals for a greater duration than their medical conditions necessitate. This has led to ‘bed blocking’, with delayed discharges being the equivalent of 13% of all NHS beds.
A key issue that contributed to the current crisis is the financial management of the NHS, impacting both quality of care and productivity. Darzi has recognised that whilst there has been a strategic intention to move spending from reactive secondary care settings to preventive community settings. However, in reality secondary care spending has grown, meaning budget allocation for community and social care settings has decreased.
Furthermore, Lord Darzi highlighted that 2010s marked the most austere decade for the NHS since its founding in 1948, with annual funding increases averaged just over 1%. Crucially, although a 3.4% annual increase was negotiated in 2018, the commitment didn't fully materialise, leaving the health service struggling to keep pace with growing demands. The inconsistent nature of health funding has fostered uncertainty, leading to short-term investments and planning which has significantly impacted NHS Productivity – which remains far below its 2019 level.
Indeed, productivity across all care settings is a real focus of the Darzi review. No care setting emphasises this more than acute hospital services. The hospital workforce has increased 17% between 2019 and 2023, however productivity is at least 11.4% lower than it was in 2019. Low productivity impacts both staff and patient experience, impacting morale and increasing waiting times.
Darzi emphasises the need for more investment in connected systems within the NHS, with a preventative approach to healthcare needed. It's important to note that Darzi does not recommend increasing the workforce as a solution to increasing productivity, rather a whole scale change in systems, how they interact and how they are funded. A move away from single-year budgets would allow for proper planning and investment in technological solutions which can staff experience and patient outcomes.
This is an issue that our members have flagged in their engagement several times, and most recently in the roundtable session on Secure Data Environments, as companies seek the assurance that projects will be long-lived before investing time and resources.
The report highlights a significant gap between the NHS and other sectors in digital transformation stating that the NHS is in the "foothills of digital transformation," having missed crucial opportunities over the past decade to embrace technologies that could shift the healthcare model from 'diagnose and treat' to 'predict and prevent'.
The report also found that the NHS is vastly underusing the potential of Information Technology, with IT projects continuing to be seen as a burden on clinicians rather than alleviating issues.
Technological solutions that have been standard in the private sector for over 15 years has led to the NHS struggling to leverage information technology due to the low digital maturity across much of the services but especially secondary care providers, widely documented by the Digital Maturity Assessment score. This imbalance is particularly concerning given the shift in disease burden towards long-term conditions, which requires information systems that work across different care settings. Even though investments have been made in projects like the Federated Data Platform and various healthcare apps, many of these initiatives remain subscale or underutilised.
Indeed, the report recognises the potential of the NHS App but finds that it is not living up to its potential impact despite its vast registered user base. Indeed, the report highlights the need to deliver a ‘digital first’ experience that the public have come to expect as standard in other areas of their life, for example in being able to book GP appointments via the App, which would improve efficiency and patient experience.
Additionally, the potential of new technologies such as virtual wards, which can be utilised as a substitute for in-person hospital care. The use of novel technologies such as this has the potential to reduce attendances and admissions to hospitals, and reduce the duration of a patient’s stay in secondary care settings.
The review also recognises that some Trusts are already tapping into the potential benefits of Artificial Intelligence. However, there is a clear need for an overall AI strategy, addressing issues such as ethics and regulation.
Lastly, the report highlights the untapped potential of NHS datasets. While there are some breakthroughs in data sharing, such as the Whole Systems Integrated Care dataset in north-west London and the OpenSAFELY programme, their capacity to transform care remains largely unrealised.
The review outlines a system in need of serious reform, particularly regarding capital finance systems, it also indicates an opportunity to embed technology as part of the solution.
Although decades of "capital starvation" have resulted in far-reaching consequences, the report acknowledges that there must be a major shift towards technology to unlock productivity and transform care. However, the report caveats that investment in technology alone will not solve the problem, and this needs to be combined with investment in the workforce, estate and medical equipment.
It is clear implementing digital health technologies is now a non-negotiable if the NHS is to meet its priority of ensuring the recovery of core services and productivity.
techUK has launched a Life Sciences workstream, bringing together members actively working in drug discovery, digital therapeutics, data and AI, or those interested in moving into this space. As the Life Sciences sector looks to introduce digital health technologies into its portfolio, techUK are shaping the conversation.
The Interoperability Working Group will work towards achieving the vision set out in NHS England’s 2022 draft standards and interoperability strategy. The group will aim to encourage the adoption of open standards and fluidity of data whilst recognising the commercial needs of members. It will also focus on demonstrating the value of interoperability to NHS senior management and improving the abilities of SMEs to implement interoperability standards.
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