Lord Darzi’s report on the state of the National Health Service in England

In July 2024, the Secretary of State for Health and Social Care, Wes Streeting, commissioned Lord Darzi to conduct an independent investigation of the NHS. This report provides an expert understanding of the current performance of the NHS across England as well as the challenges. 

We welcome the Independent Investigation of the NHS in England and its focus on addressing the critical issues facing the NHS, including mental health services.  

The impact of austerity in funding and capital, the COVID-19 pandemic, lack of patient voice and staff engagement, and management structures and systems have all contributed to the dire state of the NHS.  

As highlighted in the report, the growing number of people affected by chronic mental health conditions demands urgent attention. We know that the pandemic and the cost-of-living crisis in particular have led to a sharp increase in poor mental health and illness, the acuity of need, and demand for services.  The report’s call for a shift from a reactive, illness-based approach to a preventative and truly integrated and coordinated model aligns with our longstanding commitment to mental health care and support that considers prevention and early intervention services in the community, the wider social determinants and its impact, and takes a whole-person, whole-system approach to improve a person’s health and wellbeing through the VCSE and social care sectors.  

The nation’s health is deteriorating. 

One of the key challenges is the impact of socio-economic determinants of health (poor quality housing, low income, insecure employment) worsening over the last 15 years with the NHS facing an increased demand for health care and support. There has also been a rise in the number of people, particularly children and young people, with mental health needs. 

The Darzi Review rightly highlights the socio-economic factors that have exacerbated poor mental health and illness, especially for communities that are marginalised. Addressing these root causes through a cross-government approach, alongside improving service delivery, is essential to achieving long-term positive outcomes for mental health across the nation. 

Long waits for treatment have become normalised. 

“As of June 2024, more than 1 million people were waiting for community services, including more than 50,000 people who had been waiting for over a year, 80 per cent of whom are children and young people. By April 2024, about 1 million people were waiting for mental health services.”   

Quality of care is mixed. 

Mostly people in the healthcare system receive high-quality care. But areas of concern include maternity care, and as highlighted by the Lampard Inquiry, NHS mental health services, where there have been scandals and inquiries. Patient safety has seen improvements with an increased number of error-free care in hospitals and a reduction in the number of suicides in inpatient mental health facilities, partly due to political attention. 

Too little is spent in the community.  

Following years of cuts, “the number of mental health nurses has returned to its 2010 level. Between 2009 and 2023 the number of nurses working in the community fell by 5 per cent, while the number of health visitors, who can be crucial to development in the first five years of life, dropped by nearly 20 per cent between 2019 and 2023.” 

We echo the report’s call for cultural change within the NHS. Mental health services must be personalised, safe and effective, accountable, and open to collaboration. This is crucial for rebuilding trust and ensuring that people receive the timely, compassionate care they deserve.  

Whilst addressing the concerns and challenges in NHS mental health services, it is equally vital to recognise the wider mental health system and the pivotal role of mental health charities (VCSE sector) providing services as being integral to this. 

As the only national organisation representing mental health charities providing services, we know the sector is essential in providing mental health care and support in the community and plays a key role in the prevention of mental illness, early intervention, as well as post-discharge from inpatient settings, supporting 8 million people in our population.   

The sector is crucial in offering solutions to the long-standing and systemic challenges facing mental health care and support, but it also requires sustainable funding, resources, and support for its workforce to address these.  

We are committed to working with Government departments, the NHS and other partners to support the implementation of these recommendations, ensuring that mental health services are accessible, effective, and capable of meeting the needs of the population now and in the future.