Keir Starmer has said the NHS must “reform or die” in response to Lord Darzi’s independent investigation into the state of the health service.
The report, commissioned by health secretary Wes Streeting and completed in just nine weeks, warned that the NHS is “in serious trouble”.
Responding to the report on Thursday, Starmer said he aims to build an NHS “that is truly fit for the future”, but admitted the starting point “couldn’t be further from that goal.”
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He said: “The NHS is at a fork in the road and we have a choice about how it should meet those demands. Don’t act and leave it to die. Raise taxes on working people. Or reform to secure its future.
“Working people can’t afford to pay more so it is reform or die.”
Read the prime minister’s speech in full below:
As you have heard today, Lord Darzi has published his independent report on the state of our NHS. It is an incredibly comprehensive analysis. Some of you will have seen it, there’s copies available, please read it.
A raw and honest assessment. That is what we asked for. And that is why I wanted to come here to the King’s Fund – home to many of our country’s leading healthcare experts.
Because your contributions are going to be vital as we get this precious institution back on its feet and build an NHS that is truly fit for the future.
And look, our starting point couldn’t be further from that goal. Public satisfaction in the NHS has fallen, from an all-time high when the last Labour government left office to an all-time low today.
Think of the impact that has on staff who are putting in so much day in day out, knowing that confidence is at an all-time low. And that is because, as everybody in the country knows, the last government broke the NHS.
But until this morning, we didn’t know the full scale of the damage, which is laid bare in the report. Even Lord Darzi, with all his years of experience, is shocked by what he discovered. It is unforgiveable and people have every right to be angry.
Not just because the NHS is so personal to all of us or because when people can’t get the care they need, they’re off work sick, with huge costs for our economy, it’s because some of these failings are literally life and death.
Take the waiting times in A&E. More than 100,000 infants waited more than 6 hours last year and nearly a tenth of all patients are now waiting for 12 hours or more, that’s not just a source of fear and anxiety, it’s leading to thousands of avoidable deaths. And that phrase avoidable deaths should always be chilling.
That’s people’s loved ones who could have been saved. Doctors and nurses whose whole vocation is to save them hampered from doing so. It’s devastating. Heartbreaking. Infuriating. And that’s just scratching the surface.
High-risk heart attack patients waiting too long for urgent treatment, cancer diagnosis waiting too long, with cancer death rates higher than other countries. And when it comes to getting help for mental health, 345,000 are waiting over a year. That’s roughly the entire population of Leicester.
And look, here’s the crucial point. The Tories would have you believe all of this is because of a once in a generation pandemic but today’s report clearly shows that this is just not true.
Covid hit our NHS harder than healthcare systems in other countries. The NHS delayed, cancelled, or postponed far more routine care during the pandemic than any comparable health system.
And why? Because our NHS went into the pandemic in a much more fragile state.
Fewer doctor, fewer nurses and fewer beds than most other high income health systems. And let’s be clear about what caused that. That ideologically-driven, top-down re-organisation of 2012 from former Health Secretary Andrew Lansley.
Hopelessly misconceived, cost a fortune, and then had to be reversed. What Lord Darzi describes as a “calamity without international precedent”. A “scorched earth” approach to health reform, the effects of which are still felt to this day.
And at the same time, they inflicted what the report describes as: “the most austere decade since the NHS was founded”.
Crumbling buildings, decrepit portacabins, mental health patients in Victorian-era cells infested with vermin. When we say they broke the NHS, that’s not performative politics.
Just look at it. The 2010s were a lost decade for our NHS. A lost decade in which the Conservatives left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow.
And it’s not just the state of our National Health Service in crisis. It’s also the state of our national health. We’re becoming a sicker society. Spending more of our lives in ill-health than ten years ago.
There are 2.8 million people economically inactive because of long-term sickness. As today’s report makes clear – “The NHS is not contributing to national prosperity as it could.”
Getting people back to health and work would not only reduce the costs on the NHS. It would help drive economic growth – and fund public services.
But perhaps Lord Darzi’s most damning finding is about the declining physical and mental health of our children.
Fewer children getting vaccinated, while those from the most deprived backgrounds are twice as likely to be obese by reception age.
And much of this is a direct result of wider social injustices – poor quality housing, lower incomes, insecure employment, all of it, not just damaging the health of our nation, it’s piling up the pressures on our NHS.
That’s the report. But look, I haven’t come here just to set out this appalling inheritance. Though it is really important that we know it and properly understand it in detail.
My Labour Government was elected on a mandate for change so I’m also here to talk about how together we fix it. I feel very deeply the profound responsibility for this. And indeed, the opportunity of this moment.
The NHS may be broken, but it’s not beaten. As the report says, the NHS may be in a “critical condition”. But “its vital signs are strong”. And we need is the courage to deliver long-term reform.
Major surgery not sticking plasters.
We’ve got to face up to the challenges, look at our ageing society, and the higher burden of disease.
Look, the NHS is at a fork in the road. And we have a choice about how it should meet these rising demands. Don’t act and leave it to die.
Raise taxes on working people or reform to secure its future. Working people can’t afford to pay more. So it’s reform or die.
So let me be clear from the outset, what reform does not mean. First, it does not mean abandoning those founding ideals. Of a public service, publicly funded, free at the point of use
That basic principle of dignity, inspired of course by Bevan, that when you fall ill you should never have to worry about the bill.
That is as true today as when the NHS was founded 76 years ago. And I believe that so deeply.
As some of you will know, my mum and my sister both worked for the NHS. My wife works for the NHS. The NHS cared for my Mum throughout what was a very long illness. The NHS runs through my family like a stick of rock.
And you know, this isn’t just about emotion. It’s about hard facts too. The NHS is uniquely placed for the opportunities of big data and predictive and preventative medicine.
So, the problem isn’t that the NHS is the wrong model, it’s the right model, it’s just not taking advantage of the opportunities in front of it. And that’s what needs to change.
Second, reform does not mean just putting more money in. Of course, even in difficult financial circumstances, a Labour government will always make the investments in our NHS that are needed. Always.
But we have to fix the plumbing before turning on the taps. So, hear me when I say this, no more money without reform.
I am not prepared to see even more of your money spent on agency staff who cost £5,000 a shift, on appointment letters, which arrive after the appointment or on paying for people to be stuck in hospital just because they can’t get the care they need in the community.
Tonight, there will be 12,000 patients in that very position – that’s enough to fill 28 hospitals. So, we can’t go on like this.
As Lord Darzi has said – NHS staff are “working harder than ever” – but “productivity has fallen.”
Because patients can’t be discharged, and clinicians are spending their time trying to find more beds, rather than treating more patients.
That isn’t just solved by more money – it’s solved by reform. And third, reform does not mean trying to fix everything from Whitehall. It really doesn’t.
When Lord Darzi says the vital signs of the NHS are strong. He’s talking about the talents and passion of our NHS workforce. That’s what he’s talking about. The breadth and depth of clinical talent. The extraordinary compassion and care of our NHS staff.
If we are going to build an NHS that is fit for the future, then I tell you, we are going to do it with our NHS staff and, with our patients too.
We are going to change it together. Now, that starts with the first steps – 40,000 extra appointments every week.
But we’ve got to do the hard yards of long-term reform. So this government is working at pace, to build a Ten-Year Plan.
Something so different from anything that has gone before. This plan will be framed around three big shifts, three fundamental reforms, which are rooted in what Lord Darzi has set out today.
First, moving from an analogue to a digital NHS. Already we can see glimpses of the extraordinary potential of technology, like the world’s first ever non-invasive, knifeless surgery for Kidney cancer. Just imagine that. Pioneered by Leeds Teaching Hospitals.
Or the precision cancer scanners I saw just yesterday. Or simply for transforming how we manage a condition.
We went to Kingsmill Hospital earlier this year and met a 12-year old called Molly. She used a smartphone to monitor her glucose levels, instead of being forced to repeatedly prick her fingers. It made such a difference to her daily life and gave great reassurance to her mum who could remotely check on the settings and the findings.
We’ve got to make these opportunities available to everyone. We’ve got to use technology to empower patients and give them much greater control over their healthcare.
Take an innovation like the NHS app. This could be a whole digital front door to the NHS. Appointments, self-referral, reminders for check-ups and screenings. Patients in control of their own data. Healthcare so much more transparent, so you always know your options and the standards that you should expect.
And you know, earlier this year I went to Alder Hey Hospital. Many of you will know it, it’s a fantastic hospital, where they carry out heart surgery on infants, which is really humbling to see.
I met the parents of a two-year old who had extremely complicated heart surgery. A tiny infant, an incredible surgery. I asked them about their child’s history and condition, how did he come to be here, what’s the story behind it and as they told me, I could see them welling up as they went through the history, conditions, all the background. Then they told me that every time they went to a different hospital, they had to go through all of that over and over again. They really struggled to tell the story and they have to do this every single time. Because the records weren’t held electronically.
We’ve got to have fully digital patient records. So that crucial information is there for you wherever you go in our NHS. And while I’m on technology, we’re also going to throw the full weight of the British Government behind our world leading life sciences.
Second, we’ve got to shift more care from hospitals to communities. Now The King’s Fund has long called for this. Successive governments have repeatedly promised it, but what’s happened? The opposite. The share of the NHS budget spent on hospitals has actually increased.
Now this Ten-Year plan has to be the moment we change this. The moment we begin to turn our National Health Service into a Neighbourhood Health Service. That means more tests, scans, healthcare offered on high streets and town centres, improved GP access. bringing back the family doctor.
Offering digital consultations for those who want them, virtual wards and more patients can be safely looked after in their own homes. Where we can deal with problems early, before people are off work sick and before they need to go to hospital.
And we’ve got to make good on the integration of health and social care. So we can discharge those 28 hospitals worth of patients. Saving money. Reducing the strain on our NHS and giving people better treatment.
And third in terms of the shifts, we’ve got to be much bolder in moving from sickness to prevention. Now we’ve already announced NHS health checks in workplaces. Blood pressure checks at dentists and opticians. And that is just the beginning.
Planning for ten years means we can make long-term investments in new technologies that will help catch and prevent problems earlier. And there are some areas in particular where we’ve just got to be more ambitious, like children’s mental health, or children’s dentistry.
You know, one of the most shocking things that I saw, I’ve ever seen, this was actually when I was at was at Alder Hey Children’s Hospital again, as I mentioned earlier, I went to the ward where they do heart operations. The single biggest cause of children going into that hospital between the ages of 6 and 10 was to have their rotting teeth taken out. I couldn’t believe it. I was genuinely shocked.
All politicians say they are shocked too often, but I was honestly shocked, the single biggest cause of going into hospital of children between 6 and 10 is having their teeth taken out.
Can you think of anything more soul-destroying? For those children what a price to pay. And for that brilliant NHS team who want to use their talents to save lives. Instead spending their time taking out rotting teeth. Something that could be so easily prevented.
And look, I know some prevention measures will be controversial. I’m prepared to be bold even in the face of loud opposition. So no, some of our changes won’t be universally popular. We know that.
But I will do the right thing – for our NHS, our economy, and our children. Now, the task before us is the work of our generation.
We’ve already hit the ground running. Negotiating an offer to end the strikes, where the Tories refused to do. Strikes that were costing us all a fortune.
And we inherited 1,000 trainee GPs who were set to graduate into unemployment, instead we hired them.
But only fundamental reform and a plan for the long-term can turn around the NHS and build a healthy society. It won’t be easy, it won’t be quick. It will take a ten-year plan.
Not the work of just one Parliament. But I know we can do it.
Because we’ve done reform before. The last Labour government reformed the NHS to deliver better outcomes for patients and better value for taxpayers.
Conservative Governments then undid that good work. Which only goes to prove once again that only a Labour government can reform the NHS.
My Labour Government has a huge mandate for change. We are mission-driven. And I think the themes of this conference today are fitting for this moment.
Challenge. Change. And hope. Because the challenge is clear before us. The change could amount to the biggest reimagining of our NHS since its birth.
And the hope, well that’s what’s really exciting and galvanising about this moment. Because if we get this right, people can look back and say – this was the generation that took the NHS from the worst crisis in its history.
Got it back on its feet and made it fit for the future.
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