The report found four inter-related factors had contributed to the ‘current dire state' of the system: austerity in funding and capital starvation; the impact of the Covid-19 pandemic and its aftermath; lack of patient voice and staff engagement; and management structures and systems.

Lord Darzi said he had been ‘shocked' by his findings, adding the NHS was in ‘serious trouble' with public satisfaction at record level levels.

Waiting times

The report found the NHS has not been able to meet the most important promises made to the people since 2015 with waiting times being missed.

As of June 2024, more than 1m 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 young people. By April 2024, about 1m people were waiting for mental health services.

Lord Darzi said A&E was in an ‘awful state'. In 2010, 94% of people attending a type 1 or type 2 in A&E were seen within four hours; by May 2024 that figure had dropped to just over 60% (and for all three types of A&E combined, performance is now at 74%).

In March 2010, there were just over 2.4m on the waiting list for procedures, of whom 200,000 had been waiting longer than 18 weeks. Of those, 20,000 had waited more than a year. By contrast, in June 2024, more than 300,000—fifteen times as many—had waited for over a year, and 1.75m had been waiting for between 6 and 12 months.

Cancer care still lags behind other countries with the 62-day target for referral to first treatment not being met since 2015 and in May 2024, performance was just 65.8%. More than 30 per cent of patients are waiting longer than 31 days for radical radiotherapy.

Rapid access to treatment has deteriorated with the time for the highest risk heart attack patients to have a rapid intervention to unblock an artery has rising by 28% from an average of 114 minutes in 2013-14 to 146 minutes in 2022- 23.

Quality and productivity

Lord Darzi said there was a ‘mixed picture' on care quality with people receiving ‘high quality' once in the system but highlighting areas of concerns such as maternity care where there have been a series of scandals and inquiries.

The investigation found too much money was spent on hospitals and too little on community care with low overall productivity.

Patients no longer flow through hospitals as they should with a desperate shortage of capital prevents hospitals being productive. In addition, the ‘dire state' of social care meant 13% of NHS beds were occupied by people waiting for social care support or care in more appropriate settings.

10-year plan

Lord Darzi also identified a number of major themes for the Government's forthcoming 10-year health plan.

These included:

• engaging staff and re-empowering patients
• locking the shift of care closer to home through hardwiring financial flows
• embracing new multidisciplinary models of care that bring together primary, community and mental health services
• bringing down waiting lists by radically improving their productivity by fixing flow through better operational management, capital investment in modern buildings and equipment, and re-engaging and empowering staff.
• tilting towards technology to unlock productivity.