Prime minister Sir Keir Starmer has pledged to move “from an analogue to a digital NHS”, following the publication of Lord Ara Darzi’s review into the state of the NHS in England.
The independent investigation, published on 12 September 2024, says that the service is in “serious trouble” and highlights “worrying health inequalities” and a deterioration in the health of the nation.
NHS surgeon and independent peer, Lord Darzi said that he was “shocked” by what he found during his investigation, adding that “quality of care has gone backwards”.
Issues flagged in the report include patients struggling to see their GP, waiting lists for community and mental health services, the “awful” state of A&E, waiting times for hospital procedures, cancer care lagging behind other countries, and cardiovascular care “going in the wrong direction”.
Drivers for this performance include a £4.3 billion raid on capital budgets between 2014-15 and 2018-19 to cover in-year deficits, as well as a shortfall of £37 billion of capital investment meaning that “there are too many outdated scanners, too little automation, and parts of the NHS are yet to enter the digital era,” Lord Darzi says.
“Over the past 15 years, many sectors of the economy have been radically reshaped by digital technologies. Yet the NHS is in the foothills of digital transformation.
“The last decade was a missed opportunity to prepare the NHS for the future and to embrace the technologies that would enable a shift in the model from ‘diagnoseand treat’ to ‘predict and prevent’—a shift I called for in High Quality Care for All, more than 15 years ago,” he writes.
Lord Darzi concludes that the NHS is in a “critical condition, but its vital signs are still strong”.
He highlights “low digital maturity” across the NHS and calls for a “major tilt towards technology to unlock productivity”, including digital systems for NHS staff working outside hospitals and using AI to transform care.
“There are many possible technologies that would support more efficient, higher quality, safer care in the community. But they are largely absent.
“Given the shift in the disease burden towards long-term conditions, there is a greater need for information systems that work across different settings,” he says.
Focus groups for the investigation found a strong perception among NHS staff that IT created an “additional burden”.
“It always seems to add to the workload of clinicians rather than releasing more time to care by simplifying the inevitable administrative tasks that arise,” Lord Darzi says.
He mentions the Federated Data Platform, as an example of significant NHS investments which “have great promise and have started to show some impact locally”.
Also he says that the NHS App has “huge potential”, but adds that it is “not currently living up to its potential impact given the vast scale of its registered user base”.
The report calls for the NHS to make better of use of patient data, which is “largely untapped either in clinical care, service planning or research”.
“With its deep and broad datasets, and the global AI hub that has emerged in the UK, the NHS could be at the forefront of this revolution, with NHS patients the first to see the benefits,” Lord Darzi says.
The report outlines the steps needed to provide integrated care, including “an understanding of the population and their needs using integrated datasets” and the whole team working to a shared care plan which incorporates preventative interventions.
In response to the investigation, Sir Starmer, said that the NHS must “reform or die” and pledged that the government would create a 10-year plan based around “moving from an analogue to a digital NHS”, as well as shifting from hospitals to communities and from “sickness to prevention”.
Amanda Pritchard, chief executive at NHS England said: “Our staff are treating record numbers of patients every day despite ageing equipment and crumbling buildings, a surge in multiple long-term illnesses, and managing the long-lasting effects of the pandemic.
“While teams are working hard to get services back on track, it is clear waiting times across many services are unacceptable and we need to address the underlying issues outlined in Lord Darzi’s report so we can deliver the care we all want for patients”.
Dr Jennifer Dixon, chief executive of the Health Foundation, said: “Darzi’s diagnosis points to some obvious priorities for NHS reform, including shifting the balance of resources towards primary care and community-based services, modernising NHS buildings and equipment, and harnessing the benefits of new technology to improve care for patients”.
She added that getting the NHS back on its feet will “require sustained investment”.
Secretary of state Wes Streeting, who commissioned the report in July 2024, said that the NHS “is broken, it’s not beaten”.
Digital health sector reactions to the report
We asked health tech leaders for their reactions to Lord Darzi’s investigation into the state of the NHS in England. Here’s what they had to say:
Dr Rachael Grimaldi, cofounder and chief executive at CardMedic:
“Darzi is right to point out that patient care is held back by outdated IT. There are still many areas in the NHS where technology is still a novelty; like language translation and communication.
“Using technology to break down communication barriers, especially in some of the most urgent or unplanned situations, is crucial. However, the existing barriers within the NHS must be dismantled to facilitate widespread adoption of technology as quite often change doesn’t filter down to the teams responsible for procurement, innovation, and digital transformation.
“It’ll be interesting to see how the new 10-year plan aims to solve the problems highlighted by Darzi and whether we’ll actually see real changes happening to tackle inequality and improve healthcare for everyone.”
Jacob Haddad, chief executive of Accurx: “The NHS is in critical condition and requires radical action to fix it. We must move with urgency to modernise how care is delivered. It is our responsibility to the staff who commit tens of millions of hours a week to the system, and the patients who rely on it day in and day out.
“As Lord Darzi’s report says, the vital signs are there, and so we must now focus on scaling the solutions that have been proven in innovative parts of the system. These focus on giving patients the care they need when they need it, and enabling healthcare professionals to deliver care in the most appropriate way.
“This patient-focussed approach to delivering care will help achieve a step change in productivity, and will ensure that the NHS can thrive over the next 76 years and beyond.”
Markus Bolton, chief executive at Graphnet:
“We agree wholeheartedly with the Darzi report. Using population health to drive the shift from treatment to prevention is a substantial part of the answer to the NHS’s problems and use of these systems is accelerating rapidly across all care settings.
“Our users are building a large library of use cases covering a wide range of conditions and the improvements in outcomes are considerable. The momentum is already building and stimulus from the new government will help considerably.”
Nick Wilson, chief executive at System C:
“Darzi has rightly pointed out about the untapped potential of NHS datasets that integrated care systems (ICSs) and trusts already have.
“A lot of suppliers also have an amazing opportunity to help with national and regional data sets for population health, maternity and pharmacy for example.
“Wes Streeting’s emphasis on a shift from sickness to prevention aligns with the need for well-integrated, technology-supported healthcare systems to maximise the potential of NHS datasets.
“Turning these insights into action would help teams make informed decisions at the point of care and ultimately deliver better outcomes.
“We would like to see the government prioritise the integration of care with existing technology systems to minimise significant delays and the substantial disruption often linked to introducing new and untested solutions across care settings.
“Unfortunately, the will to do the right thing hasn’t been strong enough to overcome the organisational, financial, and cultural barriers.
“Fundamental changes are needed in how funding flows between different care settings to incentivise true integration.”
Mindy Simon and Jack Porter, co-directors of NHS Innovation Accelerator:
“Lord Darzi’s review acknowledges extraordinary pressures facing the NHS and in turn emphasises the need for greater adaptability. At this crucial time, focusing on the healthcare solutions that are already available and ready for adoption is essential.
“Programmes like the NHS Innovation Accelerator are helping to identify and making these solutions accessible, reducing the burden on the NHS to find the capacity to source and assess them independently.
“By tapping into known evidence-based innovations, the NHS can create insights from one area of use, to improve patient care and address current challenges on a larger scale. This approach not only helps with immediate needs but also supports a positive and proactive perspective on advancing healthcare.”
Tim Barker, chief executive at Kooth:
“Lord Darzi’s new report has confirmed much of what we already know about the challenges facing the NHS, the staff that work within it, and the citizens that need it.
“Many of the findings have been clear to those working in or with the healthcare system, but the clarity and urgency of the report is providing a welcome call to action as our new government returns from the summer recess.
“Moving treatment from ‘analogue to digital’ is one of the three priorities for the NHS recently outlined by Wes Streeting. We welcome this, alongside moving treatment from ‘sickness to prevention’, and ‘hospital to community’, but we need to act now to make this vision a reality.
“Digital mental health support is not only effective, but its ability to scale quickly across whole populations, makes it an economically viable approach.
“Prioritising universal access to mental health support could have a significant impact not only on the health outcomes of the UK, but also has the potential to drive increases in GDP.”
Phil Bottle, managing director at SARD:
“Lord Darzi’s review, like others before it, highlights the significant challenges that our health and care system faces.
“It’s indisputable that a sustainable NHS needs to be more efficient, however, with such poor visibility of who is working in the NHS, and what they are expected to do it is impossible to right-size the workforce now, never mind for future demand.”
Kate Bryan, managing director at Stalis:
“The review paints a stark picture of the NHS and digital transformation. However, it should be welcomed as a positive move to tackle the challenges head-on, especially the ‘tilt to technology’.
“And while Wes Streeting’s 10-year plan can set out the long-term roadmap, action needs to be taken in the short-term.
“These practical changes must focus on data integration and sharing as it fundamentally underpins the ambitions to move from ‘diagnose and treat’ to ‘predict and prevent’.
“Surfacing innovations like AI is the right approach and relies on good quality data to deliver the best outcomes, however, there are systemic problems with siloed data that must be tackled first.
“Integrated care boards (ICBs) need to be empowered to do this, with the help of specialised data partners and the commitment from government through adequate funding and guidance.”
Richard Pugmire, chief executive at Answer Digital:
“The NHS is under immense pressure and the government has made it very clear in its early tenure that difficult financial decisions will need to be made in the forthcoming autumn budget.
“We’ve already seen budgets for AI deployment and virtual wards slashed to plug holes. However, if the Government is to deliver on its promise to move the NHS from ‘analogue to digital’, this will require funds directed in such a way that will help scale the technologies that have the biggest impact on enhancing productivity.
“Cuts and delays have already had an impact on digital initiatives across the board and I really feel for local NHS leaders who are trying to move their organisations forward with the resources available to them, but are required to rely on commitments previously built on sand.
“Lord Darzi’s assessment has been swift, and I hope for the sake of the NHS the prescribed reforms that follow in the anticipated 10-year plan are matched with the commitment required to make digital transformation possible, and quickly.”
Hilary Stephenson, managing director of Nexer Digital:
“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.”
Paul Tambeau, chief executive of Induction Healthcare:
“Not surprisingly, the Darzi report highlights the role that digital tools can have in addressing key challenges in the NHS, especially in reducing waiting lists and improving productivity across the NHS.
“Induction customers have seen real evidence of how portals, integrated with video, can reduce waiting lists, make interactions with patients more efficient, and provide real cash savings for their trust.
“They also see how digital tools deliver a better patient experience as well as improved outcomes. It’s now time to act and ensure that funding models provide an incentive for trusts to procure longer term so that they can really embed tools in a way that is integrated with existing systems and drives value and efficiencies now, as well as longer term.”
Dr Hector Zenil, founder of Oxford Immune Algorithmics:
“It would be unfair to say the NHS is uniformly behind the private sector in terms of its adoption of technology. There are teams and leaders within the NHS who are at the forefront of innovation, such as AI and virtual wards.
“The challenge is one of implementation. Adopting emerging technologies requires far more checks and balances compared to the private sector, which is absolutely right given the need to prioritise patient safety.
“However, there is also a need to articulate a vision for the health service, which helps to educate the public, policy makers and clinicians on what is required to redefine the delivery of diagnosis and treatment.
“There are costs involved in embracing any new technology and in the current economic situation, there must be a discussion about where to prioritise investment because it is not possible to address every medical issue at once.”
Dr Jay Verma, cofounder of SmartLife Health:
“There is a huge amount of talent in this country creating answers to problems being faced across the NHS, most notably around clinical capacity and making sure we are using data correctly to prevent worsening health conditions.
“Many of these providers operate in primary care, where there simply is not the time nor focused leadership to understand and implement what is available and what works.
“Over 60% of NHS funding goes into hospitals and ICBs are hospital-heavy. This needs to change.
“The best way to improve the nation’s health and thus improve NHS is to focus on education and prevention. This is best done in primary care and in the community.
“While a new laser might make for a more sensational news story, measures that reduce administrative burdens and use AI to identify high-risk patients—such as those with high blood pressure or diabetes—are likely to help more people and have a greater overall impact.”
Jonathan Patrick, chief executive of Consultant Connect:
“It’s promising to see Lord Darzi’s report calling for the rapid digitisation of the NHS. For too long the NHS has been a complete mishmash of different systems that don’t work together, it needs to change.
“Some of the computer code dates back to the 1980s and many places rely on admin personnel to do things on paper that tech can do automatically.
“We need technology that gets the most out of the doctors and hospitals we have. We should prioritise technology that improves communication between different bits of the NHS. I’ve seen first hand how this can streamline care, avoid unnecessary hospital admissions and ensure patients who need urgent treatment get it.
“The government should implement the best tech at a national level and ensure that it is rolled out across the whole of the NHS. The tech needs to be joined up and outdated systems axed. It is the only way we will see true transformation in the NHS, save money and care for those in society that need it most.”
Dr Nadine Hachach-Haram, founder and chief executive of Proximie:
“The Darzi report’s finding is unsurprising but reassuring for anyone working in healthcare.
“Better technological usage must be a priority, with trusts given adequate funding to effectively utilise technology and improve core tech systems. This would undoubtedly drive productivity and workforce gains, benefitting patient outcomes.
“The government must incentivise the NHS to effectively use data analytics; as even though the NHS (and healthcare generally) produces huge amounts of data not enough is harnessed effectively – which is a missed opportunity.
“Finally, the government needs to invest in people – the surgeons, doctors, nurses, managers, and administrative staff – and give them the tools to embrace technological innovation; encouraging a culture of continuous learning and innovation.”
Lisa Harris, chief operating at Mizaic:
“The NHS report is concerning, but it reflects something those of us working with the NHS over the past few years have been aware of and have been striving to change. We welcome the recognition of this issue and fully support the focus on leveraging technology, including electronic patient records, as a key driver for improving patient care and experience.
“The story shared about parents repeatedly having to relay their child’s medical history is heartbreaking and highlights why EPRs are essential.
“Every clinician involved in a patient’s care should have access to their complete medical history at every stage of treatment, sparing families the emotional distress of retelling their story and allowing healthcare professionals to make better-informed decisions, faster.”
Nick Lansman, chief executive at the Health Tech Alliance
“The Health Tech Alliance is pleased to see the publication of the Lord Darzi review and agrees with its assessment that patient care is being held back by the slow adoption of transformative technology, from devices and diagnostics to IT and data systems.
“Where data shows clear benefit to patient outcomes and their capacity to deliver cost savings to the NHS, health technologies should be adopted across the system in the same way as medicines. This report should now act as a catalyst for change.”
Steve Sawyer, managing director, Access HSC:
“It’s encouraging to see the recognition of underinvestment in digital transformation and the importance of shifting care closer to home by hardwiring financial flows to enable primary, mental health and community services to expand. This will make significant inroads in addressing the overall success of the integrated care agenda.
“And with the strong emphasis on technology as a driver for change, the review signals a positive evolution in scaling interoperable digital tools that tackle patient flow and help prevent people from entering acute settings.
“We often see the benefits of IT being siloed and in some cases duplicated yet the advantages of industry partners that span the care continuum – which is yet to be truly utilised – includes delivering a much more integrated ecosystem that delivers greater value and outputs from technology.
“With the Autumn Budget imminent, the hope is that the much-needed change and investment signalled by Lord Darzi will be recognised in the coming weeks.”
