Policy briefing: Lord Darzi Report

What has been announced?

Lord Darzi has delivered his much-anticipated report into the state of the NHS in England. Within his report, Lord Darzi identified four key reasons that he concludes are key to the current performance of the NHS:

1. Austerity under the Conservative-Liberal coalition government and the utilisation of the capital budget (infrastructure, equipment and estates) to subsidise the underfunded day to day spending. Lord Darzi highlights this was the most austere decade since the NHS began
2. The 2012 Health and Social Care Act, which triggered widescale NHS restructuring
3. The Covid pandemic
4. Lack of patient and staff engagement.

Lord Darzi also identified seven major themes for the forthcoming 10-year plan:

1. Engage NHS staff to improve patient care and give patients greater control over their care
2. Expand general practice, mental health and community services, using revised financial structures to support these
3. Implement care models that integrate primary, community and mental health service at the local level
4. Improve hospital efficiency through operational management, investment and staff involvement
5. Utilise technology including digital systems and AI, to enhance care delivery and efficiency across the NHS
6. Contribute to the nation’s growth by improving NHS productivity, tackling worklessness driven by ill health
7. Clarify roles, strengthen processes and balance resources across the NHS structure to improve system implementation.

Prime Minister Keir Starmer pledged the biggest reimagining of the NHS since its inception via a 10-year plan and set out three priorities to transform from an analogue to a digital service, move care from hospitals to communities and be bolder in moving from sickness to prevention.

What do we say?

We welcome much of what has been announced and agree with many of the findings of Lord Darzi. Where the report points to day-to-day underfunded spending, we have long argued that the below-inflation GOS fee increases – in the years there were increases at all – were harming the ability of the eye care sector to reach its full potential. Too often when austerity is discussed, the focus is on hospitals and GPs, but our members provide a vital service that delivers a high return on investment for the patient and the taxpayer. But the profession cannot continue to provide the service without ongoing increases in the core GOS funding.

The recommendation in the report to do more in community and primary care is welcome. Optometrists have invested heavily in equipment to deliver more technologically advanced eye care. Not only do our members have the skills, equipment and capacity to do more, but the NHS, at a time of significant financial pressure, can benefit from our members’ investment and can avoid the need for capital expenditure in key areas that it simply cannot afford.

For example, we argue that the NHS does not need to invest millions in OCT scanners and visual fields screeners for diagnostic hubs when optometrists have already done so. If the government achieves its aim of moving funding from hospitals to the community, our members can help tackle the NHS backlog by taking on work that does not need to be delivered in a hospital setting, allowing hospitals to do the things that only they can do.

The move to utilise technology is also central to this transformation. With suitable connectivity, as we have long advocated, we can ‘move data, not patients’ between clinical settings. This will provide a better, more timely and closer to home experience for patients, which closely aligns to the aims of this government.

Many of our members already deliver eye care services to housebound and vulnerable patients, but they could do more. Good eyesight is crucial to prevent falls and, as identified recently, may be beneficial in helping to tackle dementia. These interventions can help to keep patients living well for longer and tackle the trend identified by Lord Darzi, where patients are living with ill health. By enabling elderly people to live well in their own homes and reducing the need for patients to be hospitalised or to move into care homes, optometrists can play a role in tackling the social care crisis.

Finally, as already announced, our members can provide additional health checks that will help to move the NHS towards prevention. The CVD pilots already announced are one step, but as our members will know, the eye is a unique structure in terms of visualising retinal vasculature. By combining existing examinations, with blood pressure checks and similar, optometrists are perfectly placed to help to keep the nation well and to detect cardiovascular disease earlier.