The Darzi Review of the NHS

A failure to learn lessons from the covid event

The Government had asked Lord Darzi, an academic surgeon at Imperial College London, to conduct an ‘independent’ review of the National Health Service. In September 2024, his 163-page document was published. While highlighting some of the major flaws in the NHS – long waiting lists, an increase in the number of avoidable deaths, poor productivity – Darzi’s proposed solutions are trite and uninspiring, comprising little more than appeals for additional taxpayer funding and a ‘tilt towards technology’. Clearly, nothing has been learnt from the increasingly evident major deficiencies in the NHS, powerfully illustrated by some of its counterproductive responses to the covid event. It seems we must brace ourselves for more of the same in the future.

Darzi’s conceptualisation of the problem

To his credit, Lord Darzi emphatically highlights some of the key flaws in the NHS. He asserts that it is in ‘serious trouble’ and that public satisfaction with the healthcare on offer is ‘the lowest ever’. The unacceptably long waiting lists are acknowledged, along with an attempt to quantify the consequent increase in mortality; for instance, there is reference to a Royal College of Emergency Medicine estimate that delays in A&E departments are likely to be causing an additional 14,000 deaths per year.

The review also draws attention to the ‘reduced productivity’ in the NHS, and again supports this assertion with some explicit statistics: compared to 2009, there are now 35% more nurses working with adults and 75% more with children, yet ‘the number of appointments, operations and procedures … has not increased at the same pace’; and there are ‘7 per cent fewer daily outpatient appointments for each consultant, 12 per cent less surgical activity for each surgeon, and 18 per cent less activity for each clinician working in emergency medicine.’

Amnesia for prominent NHS failures during the covid event  

Lord Darzi was appointed as a Minister for Health by Gordon Brown in a previous Labour administration and, until 2019, sat in the House of Lords as a Labour peer. As such, it is hard to fathom how he can be described as an ‘independent’ reviewer. This may go some way to explaining Darzi’s neglect of several enduring deficiencies in the NHS, most of which were on show throughout the covid event.

An impartial assessor of the NHS would likely have shown curiosity around the following questions:

1.      Why, in early 2020, did our NHS morph into a mono-focused service, interested only in a supposedly novel virus with an infection mortality rate similar to that of influenza, while shutting its doors to all those with other pressing healthcare needs?

2.      Why did our NHS energetically push the experimental covid ‘vaccines’ despite accumulating evidence of the widespread harms associated with them? Why are they still promoting the jabs today?

3.      Why did our NHS operate as the epi-centre of pro-mask mania throughout the covid event when the scientific literature had long concluded that the wearing of face coverings in community settings was both ineffective and harmful? Why are some NHS Trusts continuing to push the blanket masking of staff, patients and visitors today?

4.      Why does our NHS – one of the biggest employers of people from ethnic minorities in the country – continue to spend taxpayers’ money on diversity/equity/inclusion (DEI) initiatives?

5.      What impacts do trade unions in general, and the British Medical Association in particular, have on the efficiency and productivity of our NHS?

6.      Why, throughout the covid event, did the NHS allow its name and logo to be exploited in the in the unethical campaign of psychological manipulation?

Consideration of the above questions, together with the likely reasons for the long recognised problems of low productivity and inefficiency of the NHS, would suggest other ways of improving healthcare in the UK.

Four alternative proposals to improve the NHS

Darzi’s recommendations for repairing the NHS run to little more than pumping in more taxpayers’ money (to compensate for the 14 years of  ‘chronic underinvestment’ under the Tory administration) and extending the use of technology (involving the greater deployment of ‘digital systems’ in community settings and the use of ‘AI to transform care and … to create new treatments’. I believe that more fundamental changes are required if we are to realise significant improvements in the quality of our healthcare.

Proposal 1: REDUCE THE INFLUENCE OF BIG PHARMA

The tentacles of the global pharmaceutical industry encroach into virtually every realm of NHS activity, typically ensuring that drug company profits are prioritised over the health of service users. Big Pharma representatives – bearing gifts of free lunches or tickets to Taylor Swift concerts -  habitually swoop on our health centres and GP practices to promote their latest ‘wonder drug’ and to influence doctors’ behaviour. As a result, gross overprescribing is commonplace, with antidepressants and proton-pump inhibitors (for the treatment of excess stomach acid) being prominent examples. Perverse incentives are given to healthcare providers contingent on their level of drug administration – for example, in relation to cholesterol-lowering statins, whose net benefits remain open to challenge. 

The deleterious influence of Big Pharma was starkly displayed during the covid event when the NHS energetically relayed the dubious ‘safe and effective’ mantra in their promotion of the experimental ‘vaccines’, while remaining quiet about much cheaper alternative interventions (such as Vitamin D, Ivermectin, and outdoor exercise); the drug-company profit motive would likely have shaped this uneven response. Indeed, brief inspection of the convictions sheets of Pfizer and Astra-Zeneca – both pioneering companies in the covid ‘vaccine race’ - strongly supports the assertion that Big Pharma is the most corrupt industry in the world. Furthermore, the egregious, profit-orientated motive of the pharmaceutical industry was likely to have been a significant factor in explaining why the NHS morphed into a ‘covid only’ service in 2020, shutting its doors to all those with other pressing healthcare needs, while we awaited the wonder ‘vaccines’ to save us all.

Curiously, Lord Darzi - while recognising that the ‘the absolute and relative proportion of our lives spent in ill-health has increased’ – fails to recognise the role of overuse of drugs in reaching this point. Indeed, his report encourages even closer links with Big Pharma, urging the NHS to contribute to the nation’s prosperity by giving ‘better support to British biopharmaceutical companies’.

Overall, the NHS needs to free itself from the powerful multi-national pharmaceutical industry and become much more discriminating in the commissioning of its products. 

Proposal 2: END THE MONOPOLY OF STATE OWNERSHIP

Blind faith in the benefits of a state owned healthcare system is widespread in the UK, in some ways having parallels to a religious belief. Creating less dependence on government funding – for example by transitioning towards a continental style mixed health economy, incorporating a social insurance-based system as well as taxpayer financing - would likely realise several important benefits.

Crucially, it would potentially weaken the influence of authoritarian and often-destructive global organisations. As described in a previous article, world-government fanatics are increasingly in the ascendancy, incrementally erasing the individual freedoms and basic human rights of ordinary people under the banners of purported (and dubious) existential threats of a ‘pandemic’ or ‘climate emergency’. Increasingly, the governments of Western nations slavishly collude with these globalist agendas, the UK’s NHS  - as a state-owned institution – acting as a key player.

The NHS’s unthinking implementation of diktats originating from undemocratic global organisations (such as the United Nations, the World Economic Forum, and World Health Organisation) became ever more obvious during the covid event: the often-repeated mantra of ‘safe and effective’ to describe the experimental ‘vaccines’; the uncritical championing of dehumanising masks for all, despite enduring evidence of their ineffectiveness and harms; and the exploitation of the respected NHS logo and personnel in the concerted mission to ‘nudge’ us all to comply with unevidenced and counterproductive covid restrictions.

Ending the monopoly of state ownership of the NHS would enable our central healthcare provider to act primarily for the benefit of UK citizens rather than for the global political elites.

Proposal 3: ATTENUATE THE INFLUENCE OF TRADE UNIONS

Healthcare trade unions in general, and the British Medical Association (BMA) in particular, often constituted a malign force throughout the covid event, displaying scant regard for the impacts of their actions on NHS service users. While acting in the interests of their members is, of course, the raison d’etre of trade unions, their politically motivated actions during the covid event frequently resulted in negative consequences for ordinary people.

Thus, the BMA consistently campaigned for harsher covid restrictions, vocally advocating for earlier and longer lockdowns and other counterproductive measures, such as community masking, interventions that significantly obstructed access to – and quality of - healthcare. Additionally, given their traditional left-wing bias, trade unions typically promote  identity/woke policy initiatives, which would include the NHS’s wasteful investment in diversity/equity/inclusion (DEI) officers.

However, the deleterious impact of trade unions on NHS services is most evident in the current practices of doctors. By elevating their members’ needs above those of patients, the BMA has pushed for more working from home and online consultations, and reduced hours, thereby exacerbating the previously mentioned NHS productivity problems. (A recent study found that GPs, on average, work 26-hours per week). And, of course, industrial action is never far away; the BMA General Practitioners Committee has recently advised its members on a number of ‘work to rule’ options intended to bring the NHS to ‘a standstill’, along with further threats of industrial action if they are not granted an 11% annual pay increment.   

Proposal 4: REDUCE UNTHINKING ADHERENCE TO TOP-DOWN PROTOCOLS

Since 1999, NHS clinicians have relied heavily upon guidance from the National Institute of Clinical Excellence (NICE) to decide upon optimal, cost-effective treatments for their patients. Undoubtedly, a comprehensive library of evidence-based, ‘best practice’ interventions for healthcare practitioners constitutes a useful resource to guide clinical decision making. Yet, the current overdependence on centrally constructed protocols has undesirable consequences.

Training courses for doctors and other healthcare professionals typically produce knowledgeable clinicians who are equipped to deliver optimal interventions for each individual patient. But an overreliance on top-down guidance seems to have resulted in many practitioners losing their critical thinking skills and robotically following centrally constructed directives. For instance, the traditional GP, who once expertly combined multiple information sources (the presenting symptoms, knowledge of disease processes, the patient’s medical history, lifestyle and personal preferences), has too often been replaced by a passive and unthinking operative who instinctively looks upwards for instruction from technocrats.

This over dependence on central guidance will likely have contributed to the NHS’ often-nonsensical responses to the covid event, when the large majority of professional staff just regurgitated the official narratives: ‘lockdowns save lives’; ‘masks constitute an effective viral barrier’; ‘the covid vaccines are safe and effective’. During the period 2020-2022, we desperately needed doctors to do some independent research, consider the scientific papers written by non-conflicted experts, and to re-read ethical guidance around informed consent. Instead we – for the most part – endured capitulation of the NHS to the dominant covid narrative.

Furthermore, the NICE guidance itself is not immune to malign influences that are underpinned by ideology and/or self-interest, rather than by concerns for the health and wellbeing of the populace. For example, there is evidence that Big Pharma shape the content of clinical recommendations from NICE, both directly and through the intermediary of patient special interest groups.  

In conclusion

Some alternative proposals for NHS reform have been described, aimed at improving the quality and effectiveness of UK healthcare. Of course, these somewhat radical suggestions are open to challenge and will, most likely, be anathema to many. Nonetheless, I believe that open and transparent debate around these recommendations for fundamental change in the way that the NHS operates would – at the very least - be a constructive exercise, and would (unlike Lord Darzi’s turgid appeals for more taxpayer funding and greater reliance on technology) raise the prospect of meaningful service improvements for patients.

This article was first published on the Health Advisory & Recovery Team (HART) website