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** 12 September 2024
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** UK
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** Darzi report’s diagnosis for NHS is bleak — but not terminal (#1)
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** UK health minister says NHS needs to make ‘three big shifts’ to survive (#2)
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** How will the ban on smoking in pub gardens be enforced? (#4)
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** UK
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** Darzi report’s diagnosis for NHS is bleak — but not terminal

It is a good job Lord Darzi of Denham is used to working at speed. The pioneering surgeon, who is based at Imperial College London, was given only eight weeks to produce a comprehensive 163-page report on where the NHS had gone wrong since 2001. After poring over hundreds of documents and carrying out frontline visits, his diagnosis for the health service was bleak but not terminal. “The NHS is in critical condition, but its vital signs are strong,” he concluded.

Darzi, a former Labour health minister who is now an independent peer, was appointed to lead the independent investigation into the NHS by Wes Streeting, the health secretary, one week after Labour won the general election. The report involved 80 organisations including medical royal colleges, with 600 pieces of analysis commissioned for the investigation. Darzi argued that even though the NHS had been “chronically weakened”, he was confident it would pull through, although turning the health service around would take years.

“It took more than a decade for the NHS to fall into disrepair so it’s going to take time to fix it. But we in the NHS have turned things around before, and I’m confident we will do it again,” Darzi said. Here are the key findings of the report, which is set to underpin the government’s NHS policy over the next decade.

The NHS was “starved of investment” in new buildings and technology as a result of austerity, the report said. Darzi said the 2010s were “the most austere decade” since the NHS was founded in 1948, with spending flatlining in real-terms until 2018.

As a result, buildings have been allowed to crumble into a state of disrepair as the capital budget was repeatedly raided to plug holes in day-to-day spending. Compared with similar nations, the NHS has been “starved” of £37 billion in capital investment. This money could have been used to build 40 promised hospitals, or refurbish every GP surgery in the country.

The report said: “Instead, we have crumbling buildings, mental health patients being accommodated in Victorian-era cells infested with vermin with 17 men sharing two showers, and parts of the NHS operating in decrepit Portakabins.”

The failure to invest in capital is also damaging productivity: NHS staff are reliant on old scanners and computers, which frequently break down and stop them seeing patients.

The NHS has breached its social contract with the British people by consistently breaking its promises to treat them on time, the report said. Since 2015 it has routinely missed almost every single target for A&E, cancer and hospital waiting times. There are now 7.6 million people waiting for routine hospital treatment, up from 2.4 million in 2010.

Record NHS waiting times are partly a result of rising demand from a “population in distress”, the report said, as millions more develop chronic illnesses. The review described a “surge” in patients suffering multiple long-term illnesses such as diabetes, high blood pressure and chronic breathing difficulties, linked to obesity and poor lifestyle. The report will be used to support calls for strict preventive measures, including bans on junk food advertising and smoking in pub gardens, as an essential step to reduce demand on the NHS.

Darzi’s report criticises decision-making under the Tories and the coalition government, including the impact of austerity and the reorganisation of the NHS under Andrew Lansley, then the health secretary, in 2012.

In his report, Lord Darzi said the “Health and Social Care Act of 2012 was a calamity without international precedent. It proved disastrous.” He added: “In the last 15 years, the NHS was hit by three shocks- austerity and starvation of investment, confusion caused by top-down reorganisation, and then the pandemic, which came with resilience at an all-time low. Two out of three of those shocks were choices made in Westminster.”

Source: The Times, 11 September 2024

See also: Department for Health and Social Care – Independent investigation of the NHS in England ([link removed])
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** UK health minister says NHS needs to make ‘three big shifts’ to survive

The NHS must undergo three “big shifts” in how it delivers care to ensure a sustainable future, Wes Streeting has said.

Speaking at the Financial Times’ Weekend festival in London on Saturday (7th September), the UK health and social care secretary said the new government would prioritise moving NHS treatment “from hospital to community”, “analogue to digital” and “sickness to prevention”.

The three shifts “are absolutely necessary, and actually existential . . . for the future of the NHS”, Streeting said.

“We’ve got to take the best of the NHS to the rest of the NHS,” he said, noting that collaboration between the health service and life sciences sector was happening but only “in exceptional cases”.

People were “living longer but . . . not living well for longer”, adding that the NHS needed to modernise and “diagnose earlier and treat faster”.

More emphasis on prevention and primary care would help ease pressure on overstretched hospitals and “push ill health and co-morbidities . . . later into retirement”, he said.

Streeting said he would work with Peter Kyle, science and technology secretary, to “bulldoze through . . . institutional barriers” in the NHS to make the service “a catalyst for great, groundbreaking science made here in Britain”.

Source: The Financial Times, 7 September 2024

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** How will the ban on smoking in pub gardens be enforced?

Writing in Conservative Home, Harry Phibbs, Local Government Editor for Conservative Home, discusses the leaked plans to ban smoking in pub gardens and talks about the implications this may have on enforcement and the black market for tobacco. Phibbs says that enforcing the regulation will be the responsibility of Trading Standards who are stretched thin, with some local councils reporting they only have one trading standards officer. Trading standards officers are responsible for a range of enforcement activity.

Phibbs points to polling which has revealed that 53% of smokers would seek out tobacco on the black market if tobacco was banned and 52% of people in the UK are concerned that a generational smoking ban will result in a growing black market.

Phibbs claims that the ban will be burdensome for staff and issues with smokers flocking to pubs where the ban is not enforced as stringently as others.

Phibbs concludes by saying that smoking is unpopular and so anti smoking measures “will get knee jerk approval”, until the ramifications of these policies are considered. He adds that this could result in more pubs closing down and handing business to the black market.

Source: Conservative Home, 12 September 2024

See also: The arguments on illicit trade are addressed in the Smokefree Action Coalition Frequently asked questions ([link removed]) . The argument that banning smoking in pub gardens will damage the hospitality trade is based on a common misunderstanding of the impact of 2007 smokefree legislation which is addressed here: Pubs aren’t dying- they are evolving ([link removed]) .

Editorial note: Comment from Deborah Arnott, Chief Executive of Action on Smoking and Health on leaked proposals to extend smokefree legislation to outdoor areas: “The priority is to get the Bill back in parliament and put on the statute book, to end smoking for the next generation and curb youth vaping. ASH would support the inclusion of powers to extend smokefree laws outdoors, subject to consultation. The Government is catching up with what the public expects, and that’s not to have to breathe in tobacco smoke in places like children’s play areas and seating areas outside pubs, restaurants and cafes. However, it’s also important to ensure that there are still outdoor areas where people who smoke can smoke in the open air, rather than inside their homes.

“Twenty years ago those who opposed banning smoking inside pubs argued it would damage business, and be unenforceable. In fact more people went to pubs after the ban came in, and compliance was 97% from day one. That was a far more radical change, smoking rates have gone down considerably since then, and the public supports extending legislation to areas outside hospitality venues, so it’s hard to see how it can damage the hospitality trade. More to the point, smoking is the leading cause of premature death and is responsible for half the difference in healthy life expectancy between the richest and poorest in society, and the economic cost to the economy in England alone is at least £21.8 Bn. The more we can do to end smoking altogether, the better it will be for everyone’s health and wellbeing.”

The local authority seizures are due to Operation CeCe which has provided significant funding for Trading standards enforcement work – increased seizures means reductions in the number of illicit cigarettes on the market not an increase.

For government data on the size of the illicit market see Measuring Tax gaps on tobacco ([link removed]) – the key measure is volume rather than value or market share as with tax going up above inflation year on year that means the value of illicit tobacco goes up, and as smoking rates go down illicit volumes could stay the same but they could go up as market share.

In 2000/01, thanks to the facilitation of the tobacco manufacturers, the illicit trade was out of control – for cigarettes one in five cigarettes smoked were illicit (20%) and customs estimated it would grow to a third in a few years if action wasn’t taken and 60% of handrolling tobacco (HRT) was illicit.

After significant investment in enforcement the illicit market declined significantly despite taxes going up above inflation. By 20202/23 after over 20 years of decline, the illicit market share had fallen from 20% to 7% for cigarettes and from 60% to 33% of HRT.
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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