Neighbourhood working and multidisciplinary teams will be the way forward for the NHS, according to the independent investigation into the system by Lord Ara Darzi.
The report, released yesterday, found that the NHS was in a ‘critical condition’, but that it can be saved if changes are made.
It said there must be a shift towards prevention and primary care and away from hospital care.
Lord Darzi, the former Labour minister who was tasked with leading a ‘rapid investigation’ into the NHS in England, said that spending in primary and community care had a ‘superior return on investment when compared with acute hospital services’, which therefore ‘made sense’ that the NHS should shift resources and strategy towards primary care.
This involves a need to ‘embrace’ multidisciplinary models of care that bring together primary, community and mental health services, he said.
He added that as the disease burden has shifted towards long-term conditions, multidisciplinary team working has become more important’. And that where multidisciplinary teams have formed, such as in PCNs, that ‘they report significant positive impact’.
However, he said NHS structures have not ‘kept pace’.
‘The problem is that to provide high-quality, multidisciplinary care in the community requires resources that often are not there. These include the right professionals with the right skills—and the modern facilities, digital infrastructure, and diagnostics to support them,’ he said.
He added that despite rising productivity within primary care, that the relative share of NHS expenditure had fallen by a quarter in just over a decade, from 24% in 2009 to 18% by 2021.
The report called for a ‘shift in the distribution of resources’.
It said: ‘Lock in the shift of care closer to home by hardwiring financial flows. General practice, mental health and community services will need to expand and adapt to the needs of those with long-term conditions whose prevalence is growing rapidly as the population age. Financial flows must lock-in this change irreversibly or it will not happen.’
Capital investment
The report also called for more funding in capital investment, with an overall NHS shortfall of £37bn in this area.
‘These missing billions are what would have been invested if the NHS had matched peer countries’ levels of capital investment in the 2010s,’ said Lord Darzi.
‘That sum could have prevented the backlog maintenance, modernised technology and equipment, and paid for the 40 new hospitals that were promised but which have yet to materialise. It could have rebuilt or refurbished every GP practice in the country.’
The investigation pointed out that the primary care estate ‘is plainly not fit for purpose’ as 20% of it predates the founding of the health service in 1948.
‘It is just as urgent to reform the capital framework for primary care as for the rest of the NHS,’ the report said.
In a speech today on the findings of the report, Prime Minister Sir Keir Starmer said there would be no more money without reform and pledged the ‘biggest reimagining of our NHS’ since its establishment.
He suggested three ‘big shifts’, including moving from analogue to digital, shifting care from hospitals to community and from sickness to prevention.
‘Only fundamental reform and a plan for the long term can turn around the NHS and build a healthy society. It won’t be easy or quick. But I know we can do it,’ said Sir Keir.
The Prime Minister also mentioned the long-term impacts of the 2012 Health and Social Care Act which Lord Darzi’s report described as ‘a calamity without international precedent’ which ‘proved disastrous’ alongside the consequences of underinvestment in the 2010s.
He said: ‘Lord Darzi describes [the 2010s] as “the most austere decade since the NHS was founded”. Crumbling buildings, decrepit portacabins, mental health patients accommodated in Victorian-era cells infested with vermin.
‘The 2010s were a lost decade for our NHS… which left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow.’
The report is set to inform the government’s 10-year plan for the NHS.
A version of this story was first published on our sister title Pulse PCN.
