Melanie Jacobsen Cox, Head of Healthcare, shares her thoughts on the recently published Darzi Report, which provides a critical assessment of the NHS and underscores the urgent need for strategic change across the healthcare sector. Let’s see what Melanie’s thoughts are.
As architects working within the healthcare construction industry, we are keenly aware of how the Darzi Report’s recommendations could impact the design and delivery of health facilities.
First Thoughts
“The recently published Darzi Report provides a critical assessment of the NHS and highlights the urgent need for strategic change across the healthcare sector. As architects working within the healthcare construction industry, we are keenly aware of how these recommendations could impact the design and delivery of health facilities. The report emphasises many challenges that have persisted since the NHS Long Term Plan of 2019, offering a clear call to realign our focus toward more integrated and community-centered care solutions.”
Darzi report reaction
The Darzi Report highlights a critical shift that must occur within the NHS. The over-reliance on acute and hospital sector investments, at the expense of GPs, mental health, and community services, must be corrected. The NHS Long Term Plan’s emphasis on illness prevention, first established in 2019, has not been realised, and in addition we now face the consequences of a healthcare system strained by insufficient social care, low diagnostic capabilities, and neglected backlog maintenance.
Moving forwards, we need to genuinely focus on creating flexible, integrated spaces that accommodate the growing demand for accessible health services in the community, particularly to pick up the shortfall in mental health services—especially for children. Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs), while a positive development, are in need of clearer direction to function effectively. Integration needs to be seen as an opportunity to breakdown silos between health providers, local authorities and private sector developers. Working together to look at long-term solutions where finance is handled separately, and the NHS becoming long-term reliable tenants might be one way of alleviating the financial pressure without re-starting a PFI scenario. The NHS is good at looking after people, looking after buildings less so.
Caught in this web of pressure are the staff left systematically dealing with an ageing population in ageing healthcare buildings. More staff doesn’t mean better service if the infrastructure is lacking or poorly maintained. The report does not look in detail at infection control failures, and the additional pressure that this places on prioritisation of required works. The sheer difficulty of removing an IPC issue once it is given the opportunity to take hold undermines the amazing work done by staff and places patients at an even higher risk than they already face.
In the midst of all of this, we are asked to embrace technology, digital and innovation, so often placed on the value engineering chopping board or only given partial investment that realises partial opportunity. In theory, digital healthcare should be able to be another pair of hands, or eyes and ears for staff and patients. Investment in technical up-skilling is required for everyone, ensuring that digital is also accessible and inclusive to all. ‘Hospitals without walls’ and ‘virtual wards’ can alleviate pressure on the acute estate by placing care back into the community, as can pre-operation diagnostic checks. As designers, our role is to explore how digital can help plug these gaps in delivering seamless healthcare through design. We can also develop our own innovative design tools to help ICBs, Trusts and estates to make better and quicker informed decisions, dissemination of estate data into agile, accessible formats to show the ‘state of the estate’ at their fingertips.
A final thought
The Darzi Report underscores the urgent need for a more balanced investment strategy that emphasises integrated, community-based healthcare. By promoting preventative care and better supporting primary and mental health services, we can alleviate pressure on hospitals and ensure that everyone gets access to the services they need. We can help to break down the silos and barriers in health through championing integrated design and using our engagement skills to open up dialogues about how our communities can be encouraged and empowered to thrive through access to local services, rather than reliance on hospitals. Only through reducing the pressure on the acute estate can we then turn our attention to a sensible, planned program of backlog maintenance, restoring our hospitals to a place of safety, reassurance and recouperation.
At HLM, we welcome the Darzi report and our portfolio of community and primary care facilities along with large scale refurbishment, maintenance and compliance works will ensure that we are expertly positioned to be able to assist the NHS in implementing the recommendations of the report.