The Royal College of Anaesthetists responds to Lord Darzi’s investigation into the NHS in England

Lord Darzi has published the report of his Independent Investigation of NHS Performance in England, commissioned by the Secretary of State for Health and Social Care in July.  

The investigation evaluated patient access, quality of care and the overall performance of the health system. Lord Darzi concludes that ‘the NHS is in a critical condition, but its vital signs are strong’. His findings will inform the Government’s 10-year plan to reform the NHS.  

As a member of the Expert Reference Group for the investigation, we were pleased to have the opportunity to contribute, drawing on our analysis of our members’ experiences of the NHS.

Dr Claire Shannon, President of the RCoA said:  

“Lord Darzi’s investigation paints a stark picture of the current state of the NHS in England. His assessment of a service that has been chronically weakened while the health of the nation has deteriorated will resonate with our members, as will the conclusion that ‘the trust and goodwill of many frontline staff has been lost’.  

“The investigation finds that the growth in hospital staff numbers has increased sharply since the pandemic and levels of employment are amongst the highest in the world. We urge the Government to look beyond the overarching figure to consider the shortages within specific groups of the NHS workforce. Research shows that the UK is only 34th in the world in terms of the ratio of anaesthetists to population, with 14.23 anaesthetists per 100,000 people, trailing far behind Germany (with 37.37) and less than some lower income European nations like Moldova with 16.12.  

“Addressing these shortages is vital for reducing patient waiting lists, which as Lord Darzi highlights have ‘ballooned’ since 2010. Our members see every day the pain and distress this causes to many patients and their families. He is right to highlight the impact of the shortage of appropriate social care services on productivity within the NHS, but it is not the only factor. The shortage of anaesthetists is also limiting our ability to get patients the operations and procedures they so desperately need. Our analysis shows that if the UK had enough anaesthetists, the NHS could potentially provide up to 1.4 million more operations and procedures every year, which would drastically improve productivity.  

“Tackling avoidable inefficiencies in the surgical pathway can also play a big part in increasing productivity. The NHS loses an estimated £400 million annually due to on-the-day cancellations of surgical procedures, but there are interventions that have been proven effective in helping to address this.  

“Delays and cancellations often occur because patients are not well enough to have surgery when they arrive at hospital. Interventions such as turning waiting lists into preparation lists, enhanced recovery programmes and earlier discharge planning have been shown to reduce waiting lists and improve patient outcomes. Preparation before surgery can reduce complications by 30-80% and length of hospital stay by several days.  

“These interventions also help to ensure patients are listened to and their needs are met. Working with patients to prepare for surgery using pre-screening programmes and supporting them through treatment programmes for pre-existing conditions and access to services such as smoking cessation enables shared decision making and empowers patients.” 

“The investigation also identifies the declining numbers of clinical academics practising in the NHS, a role that is essential for bridging the gap between research and clinical practice. As a College, we are working to address this through support for clinical academics and our Centre for Research and Improvement, which manages large scale research, audit and improvement programmes so that patients can benefit from advancements and improvements in care.”