Lord Darzi report: Social care leaders call for urgent action to address the crisis in their sector
Industry leaders have responded to the release of Lord Darzi’s independent investigation of the NHS which reveals that a decade of austerity has left the NHS in “critical condition”
The rapid review of the health service, completed in nine weeks, has revealed that many of its staff are disengaged and that there are distressingly high levels of sickness absence.
Ara Darzi, the report’s author and a surgeon and an independent peer, blamed choices made by the last government for the damage to the health service and said it would take more than five years to fix.
The report highlights how NHS England and Department of Health and Social Care (DHSC) have continued to grow its management structures over the last 10 years, with nearly 19,000 people employed across both organisations.
By itself, the DHSC had increased in size by more than 50 per cent in the past 10 years alone. Yet, despite this increase, a report by the National Audit Office concluded that it is difficult to know if it is on track to achieve it’s objectives without putting additional pressure on local authorities and ultimately social care providers.
The report notes that the proliferation of regulatory type organisations means too many resources are spent on oversight rather than care delivery. Currently, regulatory organisations employ some 7,000 staff, equating to nearly 80 regulatory staff per NHS provider trust.
While long-term reforms are critical, the report highlighted how social care and NHS services are intertwined, and swift action and collaboration between ministers, the NHS, and social care providers is essential to bring about meaningful change.
The report acknowledged that the NHS more resources than ever before, with this year’s budget totalling £165 billion, meaning the resources exist to begin addressing these issues. However, strong leadership and full commitment are essential to achieve the much-needed change.
In response sector leaders had the following responses:
Professor Martin Green, Chief Executive of Care England, commented: “Ministers must recognise that investing in and reforming social care is not just a separate issue. it is integral to the survival and success of the NHS.
“Right now, 13 per cent of NHS beds are occupied by patients awaiting social care support. These delays are not just numbers; they represent people who deserve timely care in the right setting. Until we address this backlog in social care, we will continue to see pressure mount on hospitals and the NHS.
“We are ready to engage with the government and offer solutions. The expertise exists within social care to contribute to reform for both the NHS and social care, and we are ready, able and willing to be part of the solution development and not just participate in a box ticking consultation. Now is a critical moment for change.”
Karolina Gerlich, CEO of The Care Workers’ Charity, commented: “As the report acknowledges, it is impossible to address the challenges facing the NHS without recognising its deep interconnectedness with social care. I was not surprised to see that 13 per cent of NHS beds are occupied by individuals waiting for social care support. The care workforce does an amazing job, but there are too many vacancies and insufficient funding.
“While outside of the remit of this report, it was still encouraging to see social care recognised as a vital service in its own right. We have long advocated for social care to be viewed not just as a support system for the NHS, but as an essential part of our society.
“Now social care must be given the same attention as the NHS—one cannot function without the other, and both are crucial for people to lead healthy, happy, and independent lives.”
Patti Wynn, Chief Health & Care Strategy Officer at Tunstall Healthcare, commented: “In 2012, I moved from the United States to the UK; one of the motivations for my move across an ocean was because I firmly believed that a socialised system—one that takes care of its citizens across their entire lifespan—could focus more on prevention.”
“Lord Darzi’s report and the three shifts set out by the new Health and Social Care Secretary echo this belief in the power of prevention, and reflect a shift which has already been woven into the fabric of many NHS plans over the years. I’ve had the privilege of working closely with NHS England to help design and deliver a programme to support population health management as a data-driven proactive service to enable integrated, citizen-centric care. But progress in making prevention a true reality remains slow.”
“To make progress, we must put the vulnerable people that so often receive disjointed, reactive care at the centre of our strategy—and design services and solutions that work for them. In population health management, there is a familiar benchmark that 5% of the population generates 50 per cent of the costs. As the prime minister has stressed, reform must come before significant spend. We need to look at the assets we already have.
“When we think about prevention, we don’t need to reinvent the wheel, as much of the necessary infrastructure is already in place. Through understanding the total available infrastructure across health, care the third sector and private organisations – and building ways to connect them, we can make the entire ecosystem greater than the sum of its parts.”
Dr Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG) commented: “While this was a missed opportunity to formally look at the health and social care system as a whole, Lord Darzi’s findings reflect the importance of social care in rebuilding the NHS and ensuring disabled people of all ages receive the care and health outcomes they deserve.
“Resourcing health and social care support is a significant challenge that must be addressed, but only part of the problem. For too long disabled people, autistic people and people with a learning disability have experienced a second-class service, where communication, respect and understanding of their needs has been severely lacking.”
Dr Hughes continued: “‘The inequity of disabled people’s access to and experience of healthcare must be urgently addressed. Our members are essential partners in the design and delivery of solutions that meet people’s needs and must be treated as such as the government seeks a new approach to improve the health outcomes of all in society.”
Kathryn Smith, Chief Executive of the Social Care Institute for Excellence, commented: “Although focused on the problems facing the NHS, the Darzi Review strengthens the case for acting on social care reform sooner rather than later. The Review lays bare the critical and long-standing issues facing both the NHS and the social care system, from service fragmentation and underfunding to inefficiencies and an ageing population. To resolve the NHS’s long waiting times and improve healthcare outcomes, we need to consider patient pathways across health and social care systems as a whole.
“Lord Darzi’s analysis recognises that health and social care cannot function effectively in silos; they are inter-dependent. Enabling people of all ages, not just older people, to live independently, manage long-term conditions and relieve the pressure on finite NHS and emergency services are goals of both systems. Without a coordinated approach, people will continue to face under-met and unmet care needs, and family carers will remain overstretched.
“Waiting for government action and investment on social care may prove to be a false economy. Social care must be treated as an equal partner to the NHS, and we must leverage opportunities now for upstream prevention, new models of community care and digital innovation. The NHS 10-year Plan has an important role to play in reimagining both our future national health system and social care.”
Hilary Stephenson, Managing Director of Nexer Digital, commented: “The conversation around NHS digital reform is crucial, but inclusivity must not be compromised in the drive for efficiency. A lack of investment has resulted in low digital maturity and NHS staff often lack the skills and capabilities to address technologically generated problems, which only deepens the challenges. Any digital transformation in healthcare must be accessible to all users, particularly the disabled, older users and those less digitally literate.
“While initiatives like the NHS app and online appointment booking services have streamlined access, significant gaps in accessibility remain, with some patients finding systems difficult to navigate. The review’s acknowledgement of digital exclusion is a step in the right direction, but it oversimplifies the issue.
“To address these gaps, we need we need a comprehensive approach that includes investment in technology, skills, training, and capacity, alongside meaningful staff and public engagement. We need compliance with accessibility standards like WCAG, diverse user groups in testing, user-friendly navigation, and support for digital literacy. A user-centric, cohesive approach is essential to prevent the healthcare access gap from widening.”
Melanie Williams, President of the Association of Directors of Adult Social Services (ADASS), commented said: “We support Lord Darzi’s recommendation to shift focus and funding from hospitals, towards community and mental health services.
“But social care must be at the heart of any plans to create a ‘neighbourhood NHS’, otherwise we’re at risk of failing to deliver this once-in-a-generation opportunity to transform health and social care.
“A strong, well-funded social care system is key to keeping people independent at home, healthy and out of hospital. Which is why any plan to fix the NHS requires the development of an adult social care plan in parallel and we look forward to working with the Government to develop that.”
David Stockdale, Chief Executive of the British Healthcare Trades Association (BHTA), said: “Lord Darzi’s report offers a refreshing perspective as the Government faces the realities of the NHS’s current challenges.
“The health service, its employees, and suppliers have been undervalued and underused for too long, which this report fully acknowledges.
“I’m particularly pleased to see the stated shift in focus from hospitals to community care. The BHTA stands ready and willing to support the NHS in accelerating this transition, as our members provide both the innovations and local expertise needed to usher in a new era of healthcare in the UK.”
