September 11, 2024

expert reaction to Lord Darzi’s Independent Investigation of the NHS in England

Scientists comment on Lord Darzi’s report on the NHS England. 

Professor Gillian Leng CBE, President of the Royal Society of Medicine, said:

“Lord Darzi’s report on the future of the NHS highlights some crucial issues that need to be urgently addressed.

Health inequalities have widened and as a result, we now have a population that has become less healthy, and a workforce that has become less productive. As a country, we must reprioritise our spending to address this.

This report is an excellent start to identifying key issues and I look forward to further engagement on creating long-term sustainable solutions. In particular, where difficult choices have to be made on what can and cannot be funded, we need a new process that takes public opinion into account.”

Prof Alice Gast, Emeritus Professor Chemical Engineering, Former President, Imperial College London, said:

“Lord Darzi’s timely and comprehensive review reaffirms what I have seen first-hand, which is that the UK’s place as a leader in clinical trials is under threat. There is now a clear and urgent need to improve the establishment and patient uptake of clinical trials within the UK.

For cancers, such as pancreatic cancer, where there are currently so few treatments options it is essential that the research, innovation, and clinical trial environment better facilitate access for patients. As an academic leader and as someone diagnosed with pancreatic cancer, I have seen many of these challenges myself – including in trying to get access to trials that could extend my life.

This review confirms the extent to which the NHS has fallen behind internationally, and how much it has struggled to realise the benefits of information technology. Partnerships with the private sector and charities such as Pancreatic Cancer UK provide an important way forward. It is critical that the government now addresses these challenges, starting with a focus on less-survivable cancers in the new NHS 10-year plan.”

Prof Sir Mene Pangalos, formerly Executive Vice President R&D, AstraZeneca, said:

“It is correct for Lord Darzi’s report to emphasise and recognise the importance of research and clinical trial excellence in the NHS as a conduit for improving patient outcomes in the UK. We have seen that we can do this well during the pandemic with trials such as RECOVERY. However, it is essential that patients in the UK have access to the best standard of care used around the world as these are the comparator medicines that are used in globally clinical trials. This means they need to not only be approved by the MHRA but used and adopted by our NHS.”

Beth Thompson, Chief Strategy Officer at Wellcome, said:

“Lord Darzi is right to highlight in this report that research and innovation have not been a high enough priority in the NHS. Research is one of our most powerful tools for preventing illness and for advancing world-class care for patients. It has to be considered a necessity, not a luxury.”

“To address this and the concerning decline in the number of clinical academics, the Government’s reforms must create, cultivate and support a culture of research within the NHS.” 

Professor Andrew Morris CBE PMedSci, President of the Academy of Medical Sciences, said:

“The Academy of Medical Sciences welcomes Lord Darzi FMedSci’s comprehensive and insightful investigation into the state of the NHS in England. This timely report provides a clear-eyed assessment of the current challenges facing our health service, while offering a vision for how we can build a more sustainable and equitable NHS fit for the future. 

“We are particularly encouraged by Lord Darzi’s emphasis on the critical importance of research and innovation in driving improvements in patient care and outcomes. The review’s recognition of the vital role that clinical academics play in the health service and medical research ecosystem is especially welcome. As we highlighted in our evidence submission, embedding research at the core of the NHS is essential for generating the evidence needed to transform services and improve population health.   

“The Academy stands ready to work with Government to respond to Lord Darzi’s findings, particularly around developing the research workforce, fostering a culture of innovation across the NHS and increasing the volume of patient voices. By working together to realise this vision, we can create an NHS that not only provides excellent care, but also drives scientific advances and economic growth to make medical science work for everyone.”

Prof Sir Martin Landray, Chief Executive Officer, Protas*; Professor of Medicine & Epidemiology, Oxford Population Health (University of Oxford); Co-lead, RECOVERY trial, and Honorary Consultant Physician, Oxford University Hospitals NHS Foundation Trust, said:

Clinical trials as a driver for health improvement:

“It is good to see Lord Darzi’s report feature research and innovation– and clinical trials in particular – among the opportunities for improving the productivity and quality of our National Health Service and improving the health of the population (Chapter 6). A health system that pays inadequate attention to research is one that fails to learn, fails to improve, and fails to meet the expectations of the people it serves. We saw during the pandemic how clinical trials such as the RECOVERY trial were able to answer key questions about how to treat a major health threat, leading to the widespread usage of treatments such as dexamethasone that saved many thousands of lives and the abandonment of other treatments (such as hydroxychloroquine) that, despite strong advocates, turned out to be useless. In doing so, many countries around the world have been trying to understand what made RECOVERY successful and adopt similar approaches themselves.

We must now turn that same attention to the major health challenges facing the NHS and the UK population (most of whom, quite rightly, do not consider themselves to be patients most of the time – and don’t wish to become so if they can avoid it). If we are to reduce the burden on the NHS and improve the health of the nation, then evaluating how best to prevent common conditions such as heart disease, reduce the complications of conditions such as obesity, and minimise the impact of dementia is going to be critical.

The UK is in a tremendous position to be able to address these challenges through clinical trials to assess how to make best use of existing treatments as well as to determine which of many exciting new treatments are in fact useful. For example, new once or twice yearly injections to lower cholesterol and blood pressure, increasing options to increase weight loss, and vaccines for Alzheimer’s disease are all coming through the biopharmaceutical pipeline. Whether these technically innovative products yield real benefits for people and economic advantages for the health service and society is unknown.

The NHS has a choice – whether to be a follow-on, piecemeal adopter, long after other countries have taken advantage of the new opportunities; or instead be at the forefront of the effort, working constructively with the international biopharmaceutical industry, generating evidence that is directly relevant to the UK population, and then rolling out those therapies that are proven to be beneficial for the NHS and the people it serves. The Lord O’Shaughnessy report deals with much of the underpinning administrative and organisational issues that need to be sorted out if the UK is to deliver a greater proportion of the current commercial clinical trial activity.

But the NHS and the government should set their ambitions much higher if they wish to use those improvements to address some of the biggest issues facing the NHS.

The RECOVERY trial showed just how successful the UK can be in delivering clinical trials that transform clinical care and public health. Furthermore, the feedback from frontline NHS clinicians up and down the country was that it was so much more rewarding to be contributing to the discovery of solutions rather than merely trying to cope with the day-to-day onslaught of a public health crisis in the hope that one day an effective treatment might emerge from a trial carried out somewhere else.”

Data and technology:

“Lord Darzi quite rightly points to the opportunities for increased productivity and quality of care. But headline-catching technology such as AI, patient portals, and digital support systems need reliable, secure, and well-connected data (and the basic systems to store and manage it). At present, the basics of desktop clinical and office systems are slow, unreliable and devastatingly user unfriendly (adding cost, time, and frustration to many clinical interactions). Meanwhile data are in silos – hospital by hospital, GP surgery by GP surgery, with little if any data available centrally on mental health or community care. As Lord Darzi highlights, this undermines the delivery of properly integrated care. It also makes it almost impossible to understand patterns of care or undertake much needed research on a national basis. For many years, the opportunities for technology and the richness of the underlying data have been talked up – yet both as a practising NHS clinician and a researcher it is deeply frustrating to see just how far the NHS lags behind areas such as personal banking, commerce, and the entertainment industry.”

*(www.protas.co.uk a not-for-profit organisation focussed on clinical trials to address common diseases)

Dame Kate Bingham, Managing Partner, SV Health Investors, said:

“I welcome the Darzi report which rightly emphasises the importance of clinical trials in the NHS and adds weight to the O’Shaughnessy report findings. I am obviously very concerned about the decline of clinical trial capability. The UK’s clinical trial delivery of Covid vaccine and therapeutic trials during the pandemic was exemplary and we need to maintain that excellence and urgency.”

Prof Cathie Sudlow, Strategic Advisor and Former Chief Scientist and Deputy Director, HDR UK, said:

“Lord Darzi’s diagnosis of the state of the NHS does not hold back, and he’s right to highlight the untapped potential of the NHS’s rich abundance of health data. If we are to meet the challenges ahead, we must fully harness the power of this data to realise the fundamental “tilt towards technology” Lord Darzi asks for. Only then we can deliver a smarter, more responsive, more agile NHS that works for everyone.”

‘Independent Investigation of the National Health Service in England’ by Professor Lord Darzi of Denham was published at 22:30 UK time on Wednesday 11th September 2024.

Declared interests

Beth Thompson: I was a member of the Expert Reference Group for this review.

Professor Andrew Morris CBE PMedSci is President of the Academy of Medical Sciences, Director of Health Data Research UK and Vice Principal of Data Science at the University of Edinburgh. 

Prof Martin Landray: Comments are my own not those I work with or for. I do not have any personal financial interests in the pharmaceutical, tobacco, alcohol, food or technology industries.

Cathie Sudlow is the author of the forthcoming independent review on the health data landscape as commissioned by Professor Sir Chris Whitty, Dr Timothy Ferris, and Professor Sir Ian Diamond.

For all other experts, no reply to our request for DOIs was received.