What should councils take from the Lord Darzi report on the NHS?

It’s no surprise that ‘fixing the NHS’ has come at the top of the government’s bewilderingly long to do list. It probably shouldn’t be a surprise that social care hasn’t, after so many governments have parked what is in some ways an even thornier challenge, and certainly one which the public is less likely to reward with votes. It is disappointing though, and apparently the sector’s disappointment has been heard within the Dept of Health and Social Care.

There are some green shoots however, if only via the Darzi Independent Investigation into the NHS, which published last week, and will be followed by a 10 Year Health Plan. Darzi has painted a devastating picture of the challenges facing the NHS, which offer evidence for the Secretary of State’s description of it as ‘broken’. If difficult, unpopular, or taxi-raising action is needed to rescue it, this report will be cited by Ministers. Darzi catalogues challenges from A&E (in an ‘awful’ state) to children’s mental health services and primary care. His remit did not include social care, or offering solutions, but he does a bit of both, giving an indication of where the forthcoming 10 Year Health Plan may take us, given how warmly government has welcomed his report, and offering some useful ways in for council leaders to initiate conversations with their NHS counterparts.

Darzi damns the impact of austerity, the Lansley reforms (we are only just returning to ‘sanity’ ten years later), going into Covid with damaged resilience, and the impact of underfunding on capital investment and uptake of tech. But he also argues that the nation’s health is declining through worsening inequalities in the social determinants in health. He calls for both staff and patients to be ‘empowered’ to ‘take as much control of their care as possible’ with an expansion in primary care, mental health and community services, in a ‘neighbourhood NHS’ which embraces ‘new multidisciplinary models of care that bring together primary, community and mental health services.’ Public Health services will play a part in this shift of resources from acute to prevention and community.

This could be read as a strong message to ICBs to pursue their place-based, population health missions, working closely with their council colleagues to create the infrastructure needed to reduce the number of people who need NHS care and shift that care out of hospital wherever possible. Perhaps the only surprising aspect of the Darzi report is the focus on the need for capital expenditure. If this focus carries through into the 10 Year Health Plan, it suggests that in a time of continued pressure on revenue budgets, there may still be capital expenditure available. Darzi identifies the need for capital expenditure to update hospitals to enable clinicians to do their jobs effectively and increase productivity. But if that’s the only place there was spending of that kind, the underlying challenges would continue growing unabated, so there is perhaps an opportunity for forward-thinking ICB leaders and their council colleagues to create the business case for investment in creating the ‘neighbourhood NHS’ which Darzi says is needed. This is something we have been working at IMPOWER with Places on already.

In systems where those conversations are not happening, this could be limited to an  – admittedly much-needed – expansion of GP practices and other community NHS services. But the only route to a sustainable NHS, and to getting back to the years in which our expectancy of living healthily and well was growing, rather than shrinking as it has done since Covid, would be for that investment to build a genuinely whole-community set of services and community capacity, bringing together the NHS, councils, the voluntary sector and crucially citizens themselves to codesign and co-deliver whole-place plans with clear structures and behaviours to deliver better outcomes. There are ICBs with that vision and Places with that capacity to create and act on what we describe as a Shared Ambition. At a time when some inter-sector relationships are becoming more and more focused on hard-nosed negotiations about who pays for what, they must become the rule, not the exception.

At IMPOWER we have been working on delivering better outcomes that cost less across the health and care interface. This has spanned admission avoidance, discharge and the health needs of children and young people. We’ll be sharing more this month on the changes that make a difference, and the role Place-based leaders can take at this pivotal time for all.