The Health and Social Interview: Lord Darzi
As the NHS reaches its 70th birthday, all eyes are turning to this great institution to appraise where it has been and where it will go next. The Health and Social interview series delves into the minds of respected health leaders, who offer their views on the future health landscape.
We begin with Professor Lord Ara Darzi, a luminary of the medical and political spheres. Lord Darzi is Director of the Institute of Global Health Innovation at Imperial College London. He also holds the Paul Hamlyn Chair of Surgery at Imperial College London and the Institute of Cancer Research, and is Executive Chair of the World Innovation Summit for Health in Qatar. He is a Consultant Surgeon at Imperial College Hospital NHS Trust and the Royal Marsden NHS Trust.
He was knighted for his services in medicine and surgery in 2002. In 2007, he was introduced to the United Kingdom’s House of Lords as Professor the Lord Darzi of Denham and appointed Parliamentary Under-Secretary of State at the Department of Health to lead a major review of the NHS, which culminated in the publication of his report, ‘High Quality Care for All: NHS Next Stage Review’, in 2008. He revisited the report in 2018 publishing ‘Better Health and Care for All’. He is currently a Non-Executive Director of NHS Improvement and was recently appointed Chair of the Accelerated Access Collaborative.
If you could change one thing in the health and care system, what would it be?
Enhance digitisation of the NHS and advance technological adoption.
What aspect of the NHS do you wish the public understood more fully?
People love the NHS and they rightly want to preserve it. But that shouldn’t mean stagnation. High quality care is a constantly moving target: to stand still is to fall back. We need to embrace the potential of the future. That means making changes that are often complex and confusing – data sharing, hospital re-configurations – and all too often we struggle to make this happen, even when it’s in the interests of patients.
How can we improve innovation in the NHS?
We need to improve access to new and innovative treatments. The gap between the best and the rest is too wide. The causes of this are complex: a lack of funding in the system, over-burdensome regulation, a culture of risk adversity. We must focus on the decommissioning of dated services and technologies and focus our energies on embracing the future.
The interim report for your review of health and care with the IPPR says that we need an extra £50bn more by 2030 in England. Do you think we can make the NHS financially sustainable in the long term?
Yes, I do. It makes no sense to suggest that the NHS, which is a ‘free at the point of need’ system is unaffordable, in comparison to a more expensive system, such as social or private insurance. Sustainability of the service is possible with a long-term funding settlement, and increased productivity. However, that alone is not enough, and will also require system reform.
You have been an advocate of service reconfigurations in the past. What do you make of STPs/ACOs/ICSs?
They have been somewhat successful in advancing the agenda of greater integration within health and between health and social care. We have seen that in areas where these changes have been made improvements in terms of quality and efficiency have been seen. But these are still islands of excellence in an ocean of the status quo. The challenge for the future is to spread what works across the country. To achieve that we need a long term funding settlement and a serious reform plan to secure the NHS and social care for future generations.
Five years on from the Health and Social Care Act coming into force, how would you sum up its impact so far?
The Health and Social Care Act 2012 is one of the biggest barriers to reform in the system. It fragmented commissioning function, increased complexity at a national level, and reinforced the role of competition within the system.
You have written that the NHS should be seen as an asset to our economy as well as for the people. How would you convince a sceptic of this?
We know that people’s health is a key determinant of economic growth. When we get it wrong it costs us money. Poor mental health alone costs the economy over £30bn per year. If we get it right – have a fit and healthy workforce – our economy will thrive. We also know that the life sciences sector is a big asset for our economy: it already generates around £64 billion in revenue each year, employing a quarter of a million people nationwide. This can continue with big data, automation and genomics in the future but we need a partnership between our NHS and our businesses to make that happen.
Do you think the occasion of the NHS’s 70th anniversary will lead to positive change in our health system?
I really do. The NHS is the prize possession of British people, and it is the aspect of the UK that the public are most proud of. If there is ever a time to arm people with the future vision and strategy of the NHS, now is the time. That is why I am working with IPPR to set out where we should go from here.
Having achieved so much in a varied career, what are your goals for the future?
My underlying goal has always been to improve safety and quality in the NHS and doing this through the fostering of innovation. I hope to continue to do so, as we are faced with new and more complex healthcare challenges.
What are you most excited about for the future?
The huge potential of advances in technology, digital health and artificial intelligence, and how they will transform the way we deliver health and social care in the future.