A capital idea? The high stakes of the Darzi report

The publication of the Darzi review marks the first major health policy milestone under the Labour Government. While the findings of the 163 pages will take a while to digest in full, the key messages are clear – there has been massive and sustained underspending on capital, the pandemic had a significant impact on performance and top down reorganisations are time consuming exercises that rarely deliver as intended.
 
To seasoned health watchers, none of this is remotely new or surprising – similar conclusions have been reached by many others on many occasions. This naturally raises the question of why Wes Streeting decided to commission the work.  
 
The answer would appear to be part of the broader approach being taken by Labour to establishing the terms on which it will govern – seeking to ensure that blame for the poor performance of public services is laid at the Conservative Party’s door, making the case for ‘change’ but managing public expectations about the likelihood of rapid improvements due to the fiscal inheritance.
 
However, it is not immediately clear that the findings of the Darzi review completely align with this strategy. It clearly does make hay with the first part – the report is a litany of failures that can almost all be assigned to the period in which Labour was out of power (though it is notable that the report specifically namechecks Jeremy Hunt’s role in improving patient safety).
 
When taken to their logical conclusions however, some of the major critiques in the report could create as many problems for the government as they solve: we need more managers, to spend much more on capital, and we aren’t going to make much progress on performance by the end of the first parliamentary term.
 
All of these conclusions create headaches for Labour, even if the funding figures are useful fodder in Victoria Street ahead of the spending review – there isn’t any money for new managers, capital budgets are currently being raided to balance the books, and the public is expecting Labour to deliver improvements in performance.
 
The key tests for Streeting will therefore be whether he can work with the system to devise meaningful reforms (rather than focus on organisation restructuring) and if he can persuade a historically sceptical Treasury to provide the financial backing needed to enable change.  
 
This is an unenviable task, but Streeting has already started to lay the groundwork with his opening pitch that he wants to make the NHS an engine of economic growth. Those around Streeting have provided signals of where this direction could lead – Paul Corrigan’s conversation with the Health Foundation before the election is worth reading in full, though his comments on the NHS being held to account for delivering economic benefits through supporting people to get back into work and the need for a complete rethink on capital budgets are particularly pertinent.
 
Prior to the election, much was made by Labour of its proposed ‘mission driven’ approach to government that would bridge the gaps between departments and overcome entrenched thinking – the NHS Mission Board has by all accounts yet to have fully got going, but perhaps this is the route through which Streeting can square the circle and win over Treasury.
 
Attention will now shift from Darzi’s ‘diagnosis’ to the ‘prescription’ in the 10 Year Plan – ‘reform or die’ may need some work from a bedside manner perspective, but perhaps it is the bitter pill that is required to bring the NHS back from the brink.