Darzi – Now What?

I’ve finally had the chance to dive into Lord Ara Darzi’s compelling examination of the NHS in England: Independent investigation of the National Health Service in England. In just nine weeks, his team has produced a comprehensive and sobering snapshot of healthcare today. It resonates deeply with me, having spent over 37 years in and around healthcare. It also brought back memories of my 2008 interview with Darzi, when I was part of the team gathering insights for his “High Quality Care for All” report. His enduring message rings true: if we each take responsibility and work together, things can improve. 

But now that we have the diagnosis, the question remains: what next?

One paragraph particularly struck me:  

“At the same time, many frontline clinicians say they are working harder than ever. This appears to present a paradox. But it is possible for both to be true at the same time: productivity is not a measure of effort, but of value creation. And, as we shall see, the central problem is that patients are not flowing efficiently through hospitals anymore and neither have we upgraded the infrastructure ….with which they work. That slowdown in flow generates more non-value adding work and less output.”  (Para 54, p. 86)

Reflecting on this, I believe the first steps lie within the broader system outside hospitals, alongside some careful policy reforms.

Public Health: We must take public health seriously, both in policy and funding. The economic case for prevention is undeniable. I’ve seen the impact of laissez-faire policies over the past 15 years up close, such as in recent work in Slough on healthy weight. We need coordinated action on obesity, smoking, alcohol, exercise, and sleep, especially in the communities most affected by health inequalities. Solutions must be co-designed and delivered to local populations.

Social Care: We need bold solutions for social care. For too long, governments have shied away from tough conversations. Darzi’s piercing analysis makes it clear that we must rebuild social care—not only to ease hospital flow but also to support people in living the lives they choose, respecting their well-being and human rights.

The Voluntary Sector: Can we harness the potential of the voluntary, community, faith, and social enterprise sectors? Imagine a future where the first point of contact for mental health or well-being concerns is a local health hub created through partnerships between the voluntary sector, local government, and the NHS.

Investment in Infrastructure: We also inevitably need capital investment in facilities, equipment, and digital technology to support value creation. This will require partnerships across public, private, and charitable sectors. But let’s not neglect using the rich array of existing community social and physical assets such as libraries, community clubs, sports clubs and churches.

Finally, we must shift the narrative. The solution isn’t a 10-year plan imposed from above. We are not passive consumers of healthcare—we are active participants. Together, we must reimagine and rebuild a health and care system fit for future generations.

I would love to hear your thoughts.

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