Damning report from former health secretary finds England's NHS is plagued by long waiting times and crumbling infrastructure

The deteriorating health of the British population is also affecting the performance of the country's national health service, the report says

England's National Health Service (NHS) is “in serious trouble” due to long waiting times, outdated technology, misallocated resources and numerous other problems, with serious consequences for the country's population. That's according to a new report by NHS surgeon and former health minister Lord Ara Darzi, OM KBE FRS FMedSci HonFREng, who was commissioned by the UK's new Labor government to investigate the ailing health system. His report could also hold lessons for the U.S. health care system — including clinical laboratories.

“Although I have worked in the NHS for more than 30 years, I was shocked by what I found during this investigation – not just in the health service, but in the state of the country's health,” Darzi said in a press release released by the British government. “We want to provide high quality care to everyone, but far too many people wait too long and the quality of care has declined in too many clinical areas.”

Many of the problems he identified relate to waiting times.

“From access to general practitioners (GPs) and to community and mental health services, to accidents and emergencies, to waiting times not only for routine surgery and treatment, but also for cancer and cardiac services, waiting time targets are being missed,” he wrote in his report.

For example, “as of June 2024, more than one million people were waiting for community services, including more than 50,000 people who had been waiting for over a year, 80% of whom are children and youth,” he wrote.

Accident and emergency (A/E) care “is in a terrible state”, the report says, “queues in the emergency department have increased from an average of just under 40 people on a typical evening in April 2009 to over 100 in April more than doubled in 2024. One in ten patients now waits 12 hours or longer.”

“Over the last 15 years, the NHS has been hit by three shocks: austerity and a lack of investment, confusion caused by top-down reorganization and then the pandemic, which was accompanied by resilience at an all-time low. Two out of three of these shocks hit Westminster,” NHS surgeon and former health minister Lord Ara Darzi said in a government press release. “It has taken more than a decade for the NHS to fall into disrepair, so it will take time to fix the problem. But we in the NHS have turned things around before and I am confident we can do it again.” (Photo copyright: Health Data Research UK.)

Delays in other critical tests

The results of genetic tests also lag behind. “In 2024, more than 35,000 genomic tests will be completed each month, but only about 60% will be completed on time,” Darzi wrote.

He also noted that “only about 5% of eligible brain cancer patients have access to whole genome sequencing (WGS), which is important for treatment selection.” According to the report, only two-thirds (65 .8%) receive their first treatment within 62 days and more than 30% wait more than 31 days for radical radiotherapy.

Overall, “the UK has significantly higher cancer mortality rates than other countries, with no progress made in diagnosing stage one and stage two cancers between 2013 and 2021,” he wrote.

Patients also experienced delays in accessing cardiovascular treatments. For example, in 2013 and 2014, high-risk heart attack patients waited an average of 114 minutes for an artery-clearing procedure, Darzi noted in his report. However, in 2022-2023, the average time was 146 minutes, an increase of 28%.

“Once people are in the system, they largely receive high-quality care,” he wrote. “But there are some key areas of concern, such as maternity care, where there have been a number of scandals and investigations.”

Key factors causing delays

Darzi pointed to four key factors that led to the problems.

Lack of funding. “The 2010s were the strictest decade since the founding of the NHS, with real spending rising by around 1%,” Darzi wrote, compared with a long-term average of 3.4%.

One result was that the administration diverted funds from the capital budget to meet day-to-day needs, resulting in “deteriorating buildings that hindered productivity,” he noted.

“The maintenance backlog currently stands at more than £11.6 billion and a lack of capital means there are too many outdated scanners, too little automation, and parts of the NHS have not yet entered the digital age,” he wrote.

The COVID-19 Pandemic. Given the previous “decade of austerity,” the NHS had fewer resources to deal with the crisis than most other high-income health systems, he wrote. As a result, the NHS has “delayed, canceled or postponed far more routine care during the pandemic than any comparable healthcare system”. This has led to “a larger backlog than other health systems”.

Lack of commitment from patients and staff. Patient satisfaction “has declined and complaints have increased, while patients have fewer opportunities to make decisions about their care,” he wrote. Furthermore, “too many staff are disengaged and there are worryingly high levels of sickness absence – up to a month of work per year for every nurse and midwife working in the NHS.”

Management structures and systems. Darzi placed much of the blame on Britain's Health and Social Care Act 2012 for leading to a “costly and distracting process of almost constant reorganization of the 'central' and 'regulatory' functions of the NHS”.

One consequence, he wrote, is that too many doctors are being deployed in hospitals rather than in community care, despite successive governments promising for years to place greater emphasis on the latter.

National health in decline

Along with the problems within the NHS, “the country’s health has deteriorated and this is affecting its performance,” Darzi wrote. “There has been an increase in several long-term conditions and, particularly among children and young people, in mental health needs. Fewer children are receiving the vaccinations they need to protect their health, and fewer adults are participating in some of the most important screening programs, such as breast cancer.”

Darzi's research included frontline visits to NHS facilities as well as focus groups with NHS staff and patients, the release said. He also consulted an expert reference group made up of more than 70 organizations and examined analysis from NHS England, the UK Department of Health and Social Care and external groups.

It is interesting that there is no mention of anatomical pathology and medical laboratory testing in Lord Darzi's report. As new media outlets in the UK have reported in recent years, delays in cancer diagnosis – often up to six months – have been so severe that in 2018 the NHS announced funding for a program to create a national digital pathology network to improve productivity pathologists and reduce waiting times for cancer test results.

—Stephen Beale

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