The National Health Service is often described as the UK’s greatest achievement, an institution that embodies the principles of universal, equitable healthcare. But today, it stands at a precipice. Lord Darzi’s 2024 independent investigation lays bare a system that is not just struggling but deteriorating under the weight of chronic underfunding, a workforce stretched to its limits, and a crisis of leadership that has left many wondering whether the NHS, in its current form, is even sustainable.

At the heart of the problem is access, or rather, the lack of it. Across almost every service, waiting times have spiraled out of control. In general practice, many patients face weeks-long waits for routine appointments, with a recent BMA survey showing that 86% of GPs believe patient safety is being compromised due to workload pressures. In hospitals, the figures are even more alarming. As of December 2024, the waiting list for hospital treatment stood at approximately 7.5 million people—a slight drop from the record 7.7 million in September but still significantly higher than pre-pandemic levels. These figures represent individuals left in pain, unable to work, or having their conditions worsen while they wait. Talk about pressure on the economy.

Emergency care is in equally dire straits. In January 2024, fewer than half of patients attending A&E in England were seen within the four-hour target, one of the worst performances on record. Ambulance response times have lengthened to dangerous levels, with patients experiencing heart attacks or strokes waiting over an hour in some cases; any clinician will tell you that time equals heart muscle and brain. The government’s recent pledges to reduce waiting lists have yielded little progress, and the NHS appears trapped in a cycle of crisis management rather than long-term reform. Pulling resources from one area under scrutiny will necessarily put others under stress; a leaking dam patched with duct tape. Every time the government seals one crack, the pressure shifts, and another breach threatens to burst. Instead of reinforcing the whole structure, they scramble to plug individual holes, never addressing the deeper structural weaknesses that keep the system on the verge of collapse.

The Darzi investigation highlights a fundamental failure in capital investment. NHS buildings and equipment are crumbling, with a backlog of maintenance repairs now exceeding £10 billion. Many hospitals are still reliant on technology from the 1990s, while promised digital innovations, such as electronic patient records, remain incomplete in vast swathes of the country. The government’s much-publicised pledge to build 40 new hospitals has failed to materialize, with many projects delayed indefinitely due to spiralling costs. The reality is that without significant and sustained capital investment, the NHS will remain stuck in an outdated and inefficient model of care that serves neither patients nor staff. Another striking revelation from the report is how the UK’s NHS compares internationally. Even before COVID-19, the NHS had fewer doctors, nurses, and hospital beds per capita than most comparable healthcare systems. The pandemic only exacerbated these shortcomings. In the first year of COVID-19, the NHS postponed more non-urgent procedures than any other major European country, with hip replacements alone declining by 46% in 2020 compared to a 13% average drop across the OECD. The result is a backlog that has left millions suffering, with chronic pain and untreated conditions significantly reducing quality of life.

But while the challenges facing the NHS are stark, solutions do exist. The Darzi review makes it clear that one of the biggest priorities must be to reinvest in and empower the workforce. The NHS has suffered years of real-terms pay cuts, chronic understaffing, and a toxic culture of overwork, driving experienced professionals to leave in droves. This is particularly evident in primary care, where the number of fully qualified, full-time equivalent GPs has fallen by more than 2,000 since 2015. The government’s response, recruiting more physician associates and other support roles, does not address the core issue: the NHS needs more doctors, nurses, healthcare scientists, and other specialists, and it needs to retain those it already has. That means fair pay, better working conditions, and a genuine commitment to listening to frontline staff.

A major structural shift is also required in how and where care is delivered. Too much pressure is placed on hospitals because primary care and community services have been systematically weakened. The Darzi report recommends a fundamental shift towards prevention and community-based care, with general practice, mental health services, and district nursing playing a far bigger role. Countries such as the Netherlands and Sweden have shown that with the right incentives, care can be moved away from hospitals and into the community, improving outcomes and reducing costs in the long run. Technology must also be harnessed more effectively. While much has been made of the potential for artificial intelligence to transform healthcare, the NHS still struggles with basic IT functionality. Many hospitals and GP practices use outdated software, and administrative tasks are so inefficient that clinicians spend hours on paperwork that could easily be automated. Investment in digital infrastructure should be a priority, but it must be implemented in a way that genuinely makes the lives of NHS staff easier, rather than adding another layer of bureaucracy.

One of the most contentious debates surrounding NHS reform is whether structural changes at the top are necessary. The Darzi review argues that, while a complete reorganisation would likely cause more disruption than benefit, there needs to be far greater clarity in the roles and responsibilities of NHS England, Integrated Care Boards, and government oversight. Decision-making must become faster, particularly when it comes to capital investment. Currently, the approval process for new hospital buildings, equipment purchases, and IT upgrades is so slow and bureaucratic that vital improvements are delayed by years. However, if anything, under increasing scrutiny, bureaucracy has only worsened and positive projects end up stuck indefinitely in the middle layers of management.

The NHS is not beyond saving, but it is at a turning point. If the issues identified in the Darzi review are not addressed with urgency, the risk is not just further decline, it is a fundamental breakdown of the system. Patients will continue to suffer, staff will continue to leave, and public trust will erode. It is not enough for politicians to acknowledge the problem. Action is needed. The NHS requires proper funding, serious workforce investment, and a willingness to rethink how healthcare is delivered in the 21st century.

The debate around the NHS has been historically stuck in a cycle of short-term fixes and political point-scoring. That can no longer continue. If the government is serious about protecting the NHS, it must act now, before the system collapses under the weight of its own failures.