Unpacking the Darzi Review – Five key takeaways for diagnostic and cancer services in the NHS

The Darzi review, published last Thursday, offers a detailed and insightful analysis of the NHS's current crisis, diving straight into the heart of the issues affecting productivity, patient care, and overall system functionality. It marks a promising step forward in what I hope will be the start of a process of genuine reform for the NHS. 

Lord Darzi is both comprehensive and candid in his assessment of the NHS. The report lays bare the profound impact of Covid-19 on the NHS, exacerbated by the UK’s poor pre-pandemic capacity - a result of years of austerity and capital underinvestment. The NHS was failing to meet constitutional commitments including key cancer targets even before the pandemic, but Lord Darzi highlights that during lockdown, the UK reduced routine healthcare activity much more dramatically than other health systems due to its lack of space and facilities. 

Cancer services were particularly impacted. The UK’s reduction in mastectomies during the pandemic was the second highest among OECD countries, indicative of severe disruptions across all cancer treatments. The historic underinvestment in diagnostics further compounded these issues, leaving the NHS ill-equipped to handle the surge in demand brought about by the pandemic. We are still dealing with the fall out today.

For potentially the first time, the review directly ties the NHS's productivity struggles to a lack of capital investment and inadequate resources. Staff members are operating in an environment where they continuously feel that they are underperforming, due to systemic problems that hamper their effectiveness. The report captures the sense of frustration felt by many of us healthcare professionals who are working under impossible conditions. Despite dedication and hard work, these prevailing issues have made meaningful improvements elusive, as well as any sense of workplace satisfaction. As a result, staff goodwill has near dried out, while there has been a notable rise in sickness days. 

A critical area highlighted by the review is the inefficiency of the NHS’s digital systems. The lack of integration among various digital platforms has led to a fragmented approach to patient care. IT simply does not work for staff. Healthcare professionals often face multiple passwords and disjointed systems, which disrupts their workflow and detracts from patient interactions. The current state of digital infrastructure not only fails to improve efficiency but regularly makes the problem worse. 

Data sharing between primary and secondary care remains a significant challenge. As specialties, radiology and oncology lead in this space, yet we still face difficulties with getting the basics right. An overhaul of digital systems must enhance, rather than hinder, the delivery of care, with the experience of patients and doctors at the forefront.

While AI is making waves in radiology, promising to improve efficiency, it’s not a cure-all. Our evidence is used to demonstrate take up across the country with 56% of NHS Trusts using AI for radiology. Radiologists will always be essential for interpreting scans, and the real challenge will be integrating AI in a way that complements our expertise.

The review emphasises the need for a fundamental shift in how care is delivered. Despite the NHS’s strategy to move resources into community settings, an increasing proportion of the budget has been allocated to acute services over the years. 

In spite of the progress with community diagnostic centres only a small fraction of imaging, reporting and intervention takes place in the community. Cancer consultations and treatments take place almost exclusively in hospital. The report advocates for creative thinking about how care can be delivered closer to home, and it is now our responsibility to consider where we can support this. Such an approach could alleviate some of the pressures on hospital services and improve patient access to care.

However, the recent government commitment to double the number of CT and MRI scanners, threatens not to reduce but increase pressure on radiologists. While this expansion in equipment might seem beneficial in speeding up access, it risks massively delaying the time from scan acquisition to the patient receiving a diagnosis due to an unmanageable increase in scans. Workloads will inevitably rise, at the expense of staff satisfaction and productivity. We need an appropriate strategy to manage the workforce implications of such a policy.

Finally, the review also identifies medical leadership as a key issue in the decline of the NHS. Effective medical leadership is crucial for driving improvements within the NHS, yet current conditions make these roles less appealing. Doctors are disincentivised from taking on leadership roles due to a lack of support and recognition. To address this, we need to implement more robust support systems for medical leaders, including protected time, administrative assistance, and financial incentives.

The release of the Darzi review comes at a pivotal moment for healthcare in the UK, with a new government in place for five years, and a 10-year plan on the horizon. The review’s recommendations offer a foundation for addressing some of the most pressing issues facing the NHS, but implementing these changes will require significant investment and commitment.

While the report provides a clear diagnosis of the problems within the NHS, political realities, specifically the government’s clear stance on budget constraints, pose a challenge for improvement. Reform alone can only get us so far. Without additional investment to support the necessary developments, we will ultimately be unable to improve the NHS’s ability to meet the needs of patients and staff alike.