In July 2024, the Secretary of State for Health and Social Care commissioned Lord Darzi to conduct an immediate and independent investigation of the NHS.
Lord Darzi’s report provides an expert understanding of the current performance of the NHS across England and the challenges facing the healthcare system. Lord Darzi has considered the available data and intelligence to assess: patient access to healthcare, the quality of healthcare being provided, and the overall performance of the health system. This technical annex is packed with data, charts and graphs.
Authors
- Pages
- 331
- Published in
- United Kingdom
Table of Contents
- Independent Investigation of the National Health Service in England:Technical Annex 1
- Table of contents 2
- Notes on international comparisons 3
- I. The Health of the Nation 4
- 1. Life expectancy at birth in England 5
- 2. Trends in healthy life expectancy 6
- 3. International comparisons of avoidable mortality – preventable causes 7
- 4. International comparisons of avoidable mortality – treatable causes 8
- 5. Prevalence of long-term conditions by age band 9
- 6. Disease prevalence since 2004 10
- 7. Mental health prevalence is rising for adults and children 11
- 8. Real household income by income quintile 2001-2020 12
- 9. Poverty and deep poverty rates and children living in poverty and deep poverty 13
- 10. Food insecurity in the UK measured by emergency food supply distribution 14
- 11. Housing quality: damp problems by sector, 2019 and 2022 15
- 12. Physical inactivity among adults and children 16
- 13. Children’s use of social media and depression 17
- 14. Number of human diseases with a known genetic basis and genes known to cause human disease 18
- 15. Complexity of needs 19
- 16. Changes in NHS activity over time 20
- 17. Access to local authority supported adult social care 21
- II. Access to NHS services 22
- 1.1 NHS performance against Constitutional Standards 23
- 2.1 Performance of NHS 111: total call volume and split by speed of answer or abandoned 24
- 2.2 NHS 111 call handling 25
- 2.3 NHS app registrations and monthly usage 26
- 2.4 Use of the NHS app 27
- 3.1 Monthly GP appointment volumes 28
- 3.2 Patient reported waiting times for GP appointments 29
- 3.3 Patient-reported GP access and GP satisfaction 30
- 3.4 GP appointments per GP 31
- 3.5 Patients per GP over time 32
- 3.6 Variation in number of patients per GP 33
- 3.7 Association between number of registered patients per fully qualified GP and patient reported satisfaction 34
- 3.8 Waiting times for urgent treatment centres and walk-in centres 35
- 4.1 General dental practices availability to NHS patients 36
- 4.2 Units of Dental Activity 37
- 4.3. Proportion of adults and children registered with an NHS dentist 38
- 4.4 NHS Dentist availability to patients 39
- 5.1 Number of pharmacies in England 40
- 5.2 Walking distance to pharmacies 41
- 5.3 Community pharmacy funding 42
- 6.1 Number of new referrals to mental health services 43
- 6.2 Number of new referrals to mental health services (under 18) 44
- 6.3 Number of new referrals to perinatal mental health services 45
- 6.4 People in contact with mental health services 46
- 6.5 Size of waiting lists for mental health by weeks waiting (all) 47
- 6.6 Size of waiting lists for mental health services by weeks waiting (Under 18) 48
- 6.7 Size of waiting lists for mental health by weeks waiting (18-64) 49
- 6.8 Size of waiting lists for mental health by weeks waiting (65+) 50
- 6.9 Size of waiting lists for mental health by weeks waiting (CORE20 Aged 18+) 51
- 6.10 Patients on waiting lists for adult ADHD assessments and number in 2023 52
- 6.11 Neurodevelopmental conditions (excluding Autism) referrals since 2018 53
- 6.12 Waiting times for autism assessment for adults and children and young people 54
- 6.13 Waiting list for talking therapies 55
- 6.14 Waiting times for autism assessment for children and young people: patients with a first contact 56
- 7.1 Size of community health services waiting list, by weeks waiting (all) 57
- 7.2 Size of community health services waiting list, by weeks waiting (children and young people) 58
- 7.3 Size of community health services waiting list, by weeks waiting (all adults) 59
- 7.4 Size of waiting lists for MSK services by weeks waiting (working age adults) 60
- 8.1 Patient satisfaction with accident and emergency services 61
- 8.2 Ambulance response times by category 62
- 8.3 Demand for emergency care 63
- 8.4 Activity in emergency departments 64
- 8.5 Accident & Emergency attendances by duration of waits 65
- 8.6 All Types Accident & Emergency 4 Hour Performance 66
- 8.7 Proportion of A&E attendances by duration of waits 67
- 8.8 A&E waiting times (infants 0-2 years) 68
- 8.9 A&E waiting times (children 3-17 years) 69
- 8.10 A&E waiting times (adults 18-64 years) 70
- 8.11 A&E waiting times (adults 65 years and older) 71
- 8.12 A&E waiting times (CORE20 and rest of population) 72
- 8.13 A&E waiting times (mental health flag vs rest of population) 73
- 8.14 A&E waiting times – 12+ hour waits 74
- 8.15 Size of waiting lists by weeks waiting (all) 75
- 8.16 Size of waiting list by weeks waiting (children and young people) 76
- 8.17 Size of waiting lists by weeks waiting (working age adults) 77
- 8.18 Size of waiting lists by weeks waiting (older adults) 78
- 8.19 Size of waiting lists by weeks waiting (CORE20) 79
- 8.20 Duration of waiting times for elective activity 80
- 8.21 Elective inpatient spells for CYP and adults 81
- 8.22 Duration of waits for diagnostics 82
- III. Quality of care 83
- 1.1 Adult smoking rates 84
- 1.2 Deaths from alcohol and drug misuse 85
- 1.3. Alcohol-related deaths and affordability of alcohol 86
- 1.4 Obesity and physical inactivity 87
- 1.5 Depression diagnoses, 18+ (QOF) 88
- 1.6 Public Health Grant in real terms per capita 89
- 1.7 People in treatment for substance misuse or alcohol dependence 90
- 1.8 Reductions in public health expenditure by element of provision 91
- 1.9 Uptake of the NHS health check 92
- 1.10 Screening coverage – cancer screening programmes 93
- 1.11 Screening coverage – other adult screening programmes 94
- 1.12 Screening coverage – maternity and newborn screening programmes 95
- 2.1 Rates of onset of labour by induction, spontaneous and caesarean 96
- 2.2 Maternal BMI at first antenatal appointment 97
- 2.3 Maternal and infant mortality 98
- 2.4 Rates of stillbirth, neonatal mortality, preterm birth and serious brain injury occurring during or soon after birth 99
- 2.5. Rates of perineal tears 100
- 2.6 Babies born with low and very low birth weights over time 101
- 2.7 Inequalities in maternity outcomes 102
- 2.8 Inequalities in stillbirth and neonatal mortality rate and preterm birth rate by deprivation and ethnicity 103
- 2.9 Inequalities in maternal mortality rates by ethnicity 104
- 2.10 Deliveries per midwife 105
- 2.11 Maternity services reporting suspension of units, services or admissions in July 2024 106
- 2.12 Numbers of maternity outpatient attendances and number of maternity outpatient attendances per delivery 107
- 2.13 Universal health visiting reviews and breastfeeding prevalence at 6-8 weeks over time 108
- 2.14 Women’s reported perinatal experience 109
- 3.1 Childhood obesity prevalence 110
- 3.2 Childhood obesity prevalence by deprivation decile 111
- 3.3 Physical activity (averaging 60 minutes of activity per day) amongst 5 to 16 year olds 112
- 3.4 Smoking and vaping prevalence among children 113
- 3.5 Proportion of school pupils with education, health and care plans 114
- 3.6 Proportion of school pupils with social, emotional and mental health needs 115
- 3.7 Childhood vaccination coverage 116
- 3.7b Childhood vaccination coverage: CAGR tables 117
- 3.8 Children having 1+ emergency admissions to hospital per 10,000 children by local authority 118
- 3.9 Parents’ satisfaction with paediatric services and young people’s satisfaction with services 119
- 4.1 Referrals for outpatient appointments by source of referral 120
- 4.2 Average number of follow-up outpatient attendances per first attendance 121
- 4.3 Average length of stay by treatment function for elective overnight spells 122
- 4.4 Emergency readmissions to hospital within 30 days of discharge 123
- 4.5 Number of virtual wards beds 124
- 4.6 Impact on referrals of pre-referral specialist advice to GPs 125
- 4.7 Daily volumes of referrals and referrals diverted through use of specialist advice 126
- 4.8 Safety incidents reporting culture performance 127
- 4.9 Rates of harm-free care during NHS Safety Thermometer initiative 128
- 4.10 Number of surgical never events by type 129
- 4.11 Rates of healthcare acquired infections 130
- 4.12 Deaths from blood clot (VTE) related events within 90 days post discharge 131
- 5.1 Proportion of population with anxiety/depression entering NHS talking therapies 132
- 5.2 Recovery rate in NHS Talking Therapies 133
- 5.3 Estimated number of patients prescribed medication for ADHD 134
- 5.4 Restrictive interventions in mental health inpatient settings by age group 135
- 5.5 Numbers of inpatient mental health suicides and rate per occupied bed days 136
- 5.6 Active inappropriate out of area placements 137
- 5.7 Excess mortality in adults with serious mental illness 138
- 6.1 Daily count of Covid-19 patients in hospital 139
- 6.2 Daily count of Covid-19 patients in hospital (2024) 140
- 6.3 Uptake of autumn and spring Covid-19 vaccinations 141
- 6.4 Seasonal flu vaccination uptake (65+ years and <65 at risk) 142
- 6.5 Confirmed cases of measles 143
- 6.6 Laboratory-confirmed cases of Pertussis 144
- 6.7 Total number of newly diagnosed sexually-transmitted infections 145
- 6.8 Prevalence and treatment rates for Hepatitis C 146
- 6.9 Treatments for HCV by index of multiple deprivation decile 147
- 7.1 Prevalence of multiple long-term conditions 148
- 7.2 Care plan coverage for people with long-term conditions 149
- 7.3 Delivery of all 8 care processes for people with diabetes 150
- 7.4 COPD Patients Enrolled To and Completing Pulmonary Rehab 151
- 7.5 COPD Patients Enrolled To and Completing Pulmonary Rehab By IMD 152
- 7.6 Risk reduction for patients enrolled in NHS Diabetes Prevention Programme (DPP) 153
- 8.1 Same Day Emergency Care – Non-elective zero-day length of stay 154
- 8.2 Call-to-balloon time for higher-risk STEMI heart attacks 155
- 8.3 Variation in call-to-balloon times between ICBs 156
- 8.4 Median time from symptom onset to arrival at a stroke unit 157
- 8.5 Regional variation in median time from symptom onset to arrival at a stroke unit 158
- 8.6 Proportion of patients receiving CT or MRI brain scan < 1 hour of hospital arrival for stroke by ICB 159
- 8.7 30-day mortality for stroke survivors 160
- 9.1 Dementia prevalence 161
- 9.2 Mortality rates from dementia 162
- 9.3 Dementia diagnosis rate 163
- 9.4 People with dementia with a care plan produced or reviewed within the last 12 months 164
- 10.1 Proportion of people dying each year by place of death 165
- 10.2 International comparisons of people dying in hospital as a proportion of all deaths 166
- 10.3 Age-sex standardised admissions to hospital in the last 12 months of life by deprivation decile 167
- 10.4 Recording of end-of-life preferences on GP systems 168
- 11.1 NHS spend on nationally commissioned (specialised) services 169
- 11.2 Growth in rare and inherited disease genomic testing (Non-WGS and WGS) and associated turnaround times 170
- 11.3 NHS delivery of whole genome sequencing for rare diseases 171
- 11.4 Recommended medicines split by local or specialised commissioning 172
- 12.1 Cancer incidence over time 173
- 12.2 Cancer survival rates (all cancers) 174
- 12.3 Cancer survival rates by cancer site 175
- 12.4 International comparisons of cancer mortality 176
- 12.5 International comparisons of cancer survival 177
- 12.6 Cancer routes to diagnosis over time 178
- 12.7 Cancer routes to diagnosis by deprivation 179
- 12.8 Cancer diagnoses at stage 1 and 2 180
- 12.9 Cancer diagnosis in stage 1 or 2 by tumour type 181
- 12.10 Early diagnosis of lung cancer by indices of multiple deprivation quintile 182
- 12.11 Number of lung cancers diagnosed through the Targeted Lung Health Check (TLHC) Programme 183
- 12.12 Rollout of teledermatology to Urgent Suspected Skin Cancer pathways 184
- 12.13 Faecal immunochemical test (FIT) triage in primary care and low value colonoscopy rates 185
- 12.14 Impact of Faecal immunochemical test (FIT) rollout on Urgent Suspected Cancer lower GI referrals 186
- 12.15 Growth of cancer genomic test activity (including whole genome sequencing) and associated turnaround times 187
- 12.16 Cancer waiting times: 62-day standard – urgent suspected cancer 188
- 12.17 Radiotherapy waiting times 189
- 12.18 Time from approval to adoption for alpelisib & fulvestrant 190
- 12.19 Patient satisfaction with cancer care 191
- 13.1 Mortality rates from all circulatory disease 192
- 13.2 Under 75 mortality rate from circulatory diseases 193
- 13.2b Under 75 mortality rate from circulatory diseases 194
- 13.3 International comparisons of 30-day mortality for AMI 195
- 13.4 Premature (<75 years) deaths from heart disease by deprivation 196
- 13.5 International comparisons of 30-day mortality for stroke 197
- 13.6 Uptake of cardiac rehabilitation among eligible acute coronary syndrome patients 198
- 13.7 Variation in uptake of cardiac rehabilitation among eligible acute coronary syndrome patients across ICBs 199
- 13.8 Proportion of people at high risk of cardiovascular disease treated with lipid lowering therapies 200
- 13.9 Proportion of people with cardiovascular disease treated with lipid lowering therapies 201
- 14.1 International comparison of suicide rates 202
- 14.2 Suicide rate by year, sex, and age group for England 203
- 14.3 Suicide rate amongst adolescents aged 15-19 204
- 14.4 Suicide rate by year, sex, and age group for England 205
- 14.5 Number of suicides by mental health condition 206
- 15.1 International comparison of clinical negligence costs 207
- 15.2 Number of clinical negligence claims by clinical specialty 208
- 15.3 Clinical negligence costs by clinical specialty 209
- 15.4 Clinical negligence costs by damages value 210
- IV. Health and prosperity 211
- 1. Economically inactive people by main reason 212
- 2. Economically inactive people due to long-term sickness, by main reason 213
- 3. Recruitment to clinical research studies 214
- 4. International comparison of proportion of clinical research studies 215
- 5. International comparison of access to medicines 216
- 6. Number of technology appraisals split by recommendation 217
- 7. Technology appraisals split by cancer and non-cancer 218
- 8. Notifications of medicine supply issues and discontinuations 219
- V. Funding, investment and technology 220
- 1.1 Real terms spending on the NHS in England adjusted for population size and demographic profile 221
- 1.2 Real terms revenue expenditure on the NHS in England 222
- 1.3 Total government spending on health per person 223
- 1.4 International comparisons of health expenditure as a percentage of GDP 224
- 1.5 Total NHS surplus/deficit by year excluding central adjustments 225
- 2.1 International comparison of health expenditure per capita 226
- 2.2 International comparison of capital expenditure 227
- 2.3 NHS capital spending split by capital delegated expenditure limit and real outturn 228
- 2.4 NHS capital spending per person 229
- 2.5 Cumulative capital gap versus peers 230
- 2.6 Capital underspends and capital to revenue transfers 231
- 2.7 Capital intensity measured as ratio total capital to total revenue 232
- 2.8 NHS capital spend split by care setting 233
- 2.9 Assets to revenue by acute provider trust 2023/24 234
- 2.10 Assets to revenue by all non-acute trusts 2023/24 235
- 2.11 Age profile of the secondary care estate 236
- 2.12 Age profile of the primary care estate 237
- 2.13 Backlog maintenance by risk category 238
- 2.14 Clinical incidents caused by estates and facilities failures 239
- 2.15 Numbers of NHS beds 240
- 2.16 International comparison of bed numbers 241
- 3.1 International comparison of number of diagnostic scanners 242
- 3.2 NHS capital budget split by setting and by investment type 243
- 3.3 Capital funding for technology & data 244
- 3.4 IT capital investment per clinical FTE by NHS provider type 245
- 3.5 Digital maturity assessment of secondary care providers 246
- VI. The impact of the Covid-19 pandemic 247
- 1. Number of excess deaths in England during the pandemic years 248
- 2. International comparison of excess mortality during the pandemic 249
- 3. International comparison of health system capacity going into the Covid-19 pandemic 250
- 4. Changes in consultation rate by age and physical or mental health long-term condition status during the Covid-19 pandemic 251
- 5. Percentage of patients reporting not having seen a doctor in the last 12 months 252
- 6. Changes in hip and knee replacement surgeries from 2019 to 2020 253
- 7. Changes in cataract surgeries and mastectomy surgeries from 2019 to 2020 254
- 8. Changes in hospital discharges between 2019 and 2020 255
- VII. Staff Engagement 256
- 1. Staff satisfaction 257
- 2. Staff recommending their organisation as a place to work and staff recommending their organisation as a place to receive care 258
- 3. Changes in discretionary effort by role 259
- 4. Changes in average days lost to sickness per FTE pre and post pandemic 260
- 5. Reasons for sickness absence, average number of sick days per month 2019/20 and 2023/24 261
- 6. NHS practitioner health registrations by year 262
- 7. NHS practitioner health proportion of registration diagnosed with anxiety and/or depression 263
- 8. NHS Staff staying in post over the previous 12 months by staff group 264
- 9. NHS Staff with bank contracts 265
- 10. Total numbers of bank and agency shifts over time 266
- 11. Total annual spending on agency staff for acute trusts 267
- VIII. Where and how the money is spent 268
- 1.1 NHS resources by setting 269
- 1.2 Average NHS spend per NHS provider 270
- 1.3 Care integration 271
- 2.1 Overall NHS workforce over time 272
- 2.2 Overall NHS clinical workforce over time 273
- 2.3 Total factor productivity for the NHS in England and the whole UK economy 274
- 2.4 Total factor productivity for the NHS in England 275
- 3.1 International comparison of GPs per 1,000 population 276
- 3.2 Number of full-time equivalent GPs per 100,000 registered patients 277
- 3.3 Drivers of primary care drug spend 278
- 4.1 International comparison of nurses and midwives working outside hospitals 279
- 4.2 Changes in the community services workforce 280
- 4.3 Community nurses in post 281
- 4.4 District nurses in post 282
- 4.5 Change in the numbers of nurses by setting and by region 283
- 5.1 Changes in the mental health workforce 284
- 5.2 Mental health needs vs mental health nurses 285
- 5.3 Changes in mental health nursing staff and learning disabilities staff between 2010 and 2023 286
- 5.4 Overall mental health workforce 287
- 5.5 Mental health nursing workforce 288
- 5.6 Learning disabilities nursing workforce 289
- 5.7 Mental health medical workforce 290
- 5.8 Mental Illness and Learning Disability bed availability 291
- 6.1 International comparison of all healthcare workers employed in hospitals 292
- 6.2 International comparison of doctors, nurses and midwives employed in hospital 293
- 6.3 International comparison of specialist doctors 294
- 6.4 International comparison of nurses and midwives working in hospitals 295
- 6.5 Changes in the hospital workforce 296
- 6.6 Doctors and nurses per G&A available bed 297
- 6.7 Growth in acute hospital workforce 2019/20 – 2023/24 298
- 6.8 Total factor productivity of acute NHS provider trusts 299
- 6.9 Acute productivity gap between 2019/20 and 2023/24 300
- 6.10 Changes in staff per bed and activity per staff member 2001/02 – 2023/24 301
- 6.11 Clinical workforce productivity metrics 302
- 6.12 Size of the queue in A&E departments 303
- 6.13 Working days lost to ambulance handover delays 304
- 6.14 Bed occupancy over time 305
- 6.15 International comparisons of bed occupancy 306
- 6.16 Drivers of secondary care drug spend 307
- 6.17 Reasons for delayed discharges from acute hospitals 308
- 6.18 Delayed discharges over time and equivalent number of NHS beds 309
- IX. NHS Structures and Systems 310
- 1.1 NHS organisations created or existing during time periods 311
- 1.2 Cumulative number of NHS bodies created and abolished 312
- 1.3 Ratio of NHS provider trusts to all other NHS statutory bodies 313
- 1.4 Number of managers and senior managers moving within the NHS and leaving the NHS (turnover) 314
- 2.1 International comparisons of admin costs as a percentage of health spending 315
- 2.2 Managers and senior managers as a proportion of total NHS staff 316
- 2.3 Changes in managers per NHS employee since 2009 317
- 3.1 NHS staff working in NHS Support Organisations and Central Bodies in England 318
- 3.2 Number of NHS staff employed in non-clinical roles 319
- 3.3 Changes in the NHS infrastructure support workforce 320
- 3.4 Clinically qualified staff (FTE) working in NHS Support Organisations and Central Bodies 321
- 3.5 Employment in NHS England and other national entities relating to the NHS 322
- 3.6. National NHS organisations created and abolished since 2010 323
- 3.7 Employment in NHS England and the Department of Health and Social Care 324
- 3.8 The number of staff in NHS statutory bodies with ‘regulatory’ type functions 325
- 3.9 NHS England functions and scale 326
- 4.1 Completeness of datasets 327
- 4.2. NHS Planning, Commissioning and Improvement Data Sharing Agreements 328
- 4.3 NHS Data Sharing for Research 329
- 4.4 Combined surplus/deficit of trusts in England between 2010/11 and 2022/23 330
- 4.5 Numbers of NHS organisations authorised as Foundation Trusts for the first time 331