THE new government is determined not to learn the lessons of NHS history, dooming us to repeat it. Its embrace of Lord Darzi’s “rapid investigation” report puts this beyond reasonable doubt.

In his report, Darzi lavishes praise on Tory health policy, particularly the 2014 Five Year Forward View, its subsequent continuation, and the statutory rubber-stamping of the US accountable care organisation (ACO) system, which can be more accurately described as “cuts for cash” and was subsequently renamed integrated care systems (ICS) after bad publicity over US ACOs.

Darzi calls for Labour to continue all of this while at the same time lamenting the “massive Tory damage” to the NHS, which he appears to limit to the consequences of Andrew Lansley’s 2012 NHS and Social Care Act while discounting the hugely harmful effects of the ACO/ICS switch, which incentivises health providers for not providing care by awarding them a share of “savings” generated by doing so.

More than once, Darzi uses the rhetorical formula that “it is impossible to understand what has been happening in the NHS without understanding …” but does not nail the real fundamental issue, which is the policy influence of corporate interests, in particular the push to “move care out of hospital,” which he clearly supports and which he claims is to meet the “change in the needs of the population” that he says is “fundamental.”

The Conservatives’ ACO push has always claimed to be derived from these “changing needs of the population,” but as the constant drive to ration services, cut costs and lower the NHS workforce skill mix shows, the real driver has been increasing potential profitability.

No-one in “the population” needs years-long waiting lists, inaccessible services and a “postcode lottery,” but these are what this strategy has created. Labour has already made plain that it intends to continue this direction of travel. Darzi’s report appears tailor-made to justify it, diagnosing “problems” in line with Labour’s desired “solutions” while omitting three to four decades of cuts, closures and privatisation policy, including ACOs, as a factor.

This central tenet of ACOs was summarised by ex-Labour health minister Lord Warner in 2011. Warner noted that huge US health group Kaiser Permanente had introduced integrated care specifically to reduce hospital-based care in order to be profitable in a “competitive” health market.

In praising the 2014-onwards ACO policy, Darzi approvingly cites “pilots of integrated care [that] were well under way in 2010,” without mentioning that these pilots were set up by Kaiser Permanente and UnitedHealth based on the minimised state healthcare model they practiced in the US.

This omission has been standardised in political discussion of healthcare to help misrepresent corporate-led closures and privatisation as a socially motivated response to public needs. Infamously, Tony Blair even claimed during his time as PM that closing hospitals would save lives.

Darzi’s approval of this strategy amounts to the conclusion that it devastated NHS capacity — NHS bed numbers have fallen by around half since the 1980s — so to fix the issue we need more of the same, regretting that not enough has been done to progress the reduction in hospital care: “Since at least 2006, and arguably for much longer, successive governments have promised to shift care away from hospitals and into the community.”

ICS and the drive to cut costs and enhance profitability have also seen the government push for the significant widening of the use of “physician associates” instead of fully trained doctors.

The government’s own analysis of the use of these “associates” instead of trained doctors says it poses a “high risk” to patients, but this has not even slowed down the plan to increase their numbers or to give them respectability by regulating them through the General Medical Council, despite vocal opposition from the British Medical Association and other expert groups.

Darzi says ICS and the resultant hospital closures are better “financially” but frames this in the language of profitability, citing brazenly that it brings a “superior return on investment” and that “the NHS Budget is not being spent where it should be — too great a share is being spent in hospitals, too little in the community.

Darzi admits that hospital services suffered during Covid but does not specify that this was the result of decades of bed-cutting policies that left us with the lowest bed count in Europe, instead claiming that it was merely a cash issue, that “austerity and capital starvation” caused the poor response.

“Moving care out of hospitals” is a euphemism for closing and downgrading hospitals, which means people losing vital hospital-based services or suffering drastically reduced access to them. To advocate a continuation of the policies that led to this situation as a means of fixing it is perverse, but this is what Darzi does.

He rules out any reversal of the bed cuts policy as a solution while using the “lack of social care” language that has always been part of the “moving care out of hospital” narrative, blaming “lack of investment and cost targets” for hospital managements reducing beds, yet Darzi still calls for more of the “care out of hospitals” that really drove the bed reductions all along.

Darzi also contradicts himself, citing GPs’ complaints that too much is being pushed away from hospitals and onto them, when this is what his report advocates: “We heard significant irritation felt by GPs who perceive that more and more tasks are being shifted from secondary care back to primary care.” He still criticises the Tories for promising “40 new hospitals,” but advocates policies to push care even further away from hospitals to “lock in the shift of care closer to home.”

Health and social care expert Caroline Molloy, has noted the significance of this language shift: “We don’t call all these cuts ‘care in the community’ any more, of course. We call it ‘care closer to home’ — which it turns out often means care a lot further away, and therefore with worse outcomes.”

Health Secretary Wes Streeting talked, even in opposition, about the “need” for more “reform” along the lines of so-called integrated care, which he explicitly embraced. Keir Starmer said last week that the NHS must “reform or die,” ignoring the fact that NHS budgets are a political decision.

It seems clear that the new Labour government intends to start where the Tories left off and bleed even more services out of hospitals. The old adage about insanity involving doing the same thing and expecting different results would apply, but only if we assume that the intent is actually to make things better rather than to enhance profitability.

Darzi’s report furnishes Starmer’s government with the excuses it needs in order to do this, and this bodes extremely ill for those who rely on the services of the classic NHS that was rightly considered one of the world’s best and most efficient healthcare services.
 

Claudia Webbe is the former MP for Leicester East (2019-24). You can follow on X @ClaudiaWebbe.