Darzi review finds shortcomings in NHS capital spending on digital technology

Lord Darzi’s independent report calls for a “fundamental tilt towards technology” to help unlock productivity, particularly outside hospitals, as the workforce urgently needs the benefits of digital systems and use of automation and AI.

His rapid review of NHS performance for the new labour government lists several themes for how to improve the NHS as part of the forthcoming ten-year plan, due in spring 2025. The independent report published on 12 September 2024 looks at the performance of the NHS in England and the key drivers behind it. Digital plays a prominent part in the review. So, what does Lord Darzi’s review find?

The former minister, eminent surgeon and academic finds the NHS in “the foothills of digital transformation” due to a poor track record of capital funding. He references that “Some £4.3 billion was raided from capital budgets between 2014-15 and 2018-19 to cover in-year deficits that were themselves caused by unrealistically low spending settlements.”

Darzi sees that “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 ‘diagnose and treat’ to ‘predict and prevent’” – a shift he called for more than 15 years ago in his report High Quality Care for All.

Delivering his first health and care speech since taking office, at the King’s Fund annual conference, Prime Minister Sir Keir Starmer has pledged to move from “an analogue to a digital NHS”, one of the “big shifts” rooted in Lord Darzi’s report. Responding to Darzi’s report he also said “we’ve got to have fully digital patient records” – “offering digital consultations for those who want them.”

Key findings

The review calls on the NHS to make better use of patient data, join up health records, improve the NHS App and harness AI to transform care.

Here are some of the report’s main findings:

• The NHS App is not delivering a ‘digital-first’ experience. While nearly 80% of adults are now registered, less than 20% use it monthly. “With a huge success in registrations, an important opportunity is being missed to improve both efficiency and patient experience”.
• The NHS has been “starved” of capital, so the service has too few scanners, too little investment in digital automation in laboratories and pharmacy, and too little digital technology to support its workforce.  While there are many examples of technology having an important impact in the NHS from virtual wards to remote dermatology consultations – it has “not radically reshaped services”.

• Health and care systems continue to “struggle to fully realise the benefits of information technology” adding that it “always seems to add to the workload of clinicians rather than releasing more time to care”. It also finds that the “extraordinary richness of NHS datasets is largely untapped either in clinical care, service planning, or research” reflecting a low digital maturity across much of the NHS.
• There is mention of some NHS investments and success stories, such as the Federated Data Platform, which “have great promise and have started to show some impact locally”. Lord Darzi also references the examples of start-ups that have created apps that improve the quality and efficiency of care. “But too many of these remain subscale” with the NHS App, he says  “not currently living up to its potential impact given the vast scale of its registered user base”.

• Investment in information technology continues to focus on acute hospitals, rather than community-based services such as district nursing or mental health home treatment. The report says that there is a need to improve digital infrastructure in the community explaining that there are many possible technologies that would support more efficient, higher quality, safer care in the community.

While the Darzi review finds the NHS in a “critical condition” it does set a baseline for the upcoming ten-year plan with technology one of the obvious priorities for improving care for patients.