The Darzi Review: Race equity needs to be a key consideration in the independent review of NHS performance

One of Wes Streeting’s first acts as Secretary of State for Health and Social Care was to commission a review of NHS performance. Having already described the health service as “broken” and “wrecked”, the new Secretary of State has said he wants to uncover “hard truths”. Understandably, he’s said it’s important to “diagnose the problem” before “writing the prescription”.  

Professor Ara Darzi has once again been appointed to lead this review. His last review, conducted 16 years ago under Gordon Brown, concluded that a greater focus on quality of care and a loosening of political control would help to repair the NHS. On that occasion, the Labour government did not last long enough to see through his reforms, but now he has a second chance.  

While it’s sensible to understand what needs to be fixed before intervening, it’s notable that the review is being conducted at a rapid pace. With a call for evidence only open for a handful of days, and a report due in September, how deep can this review really dig for these hard truths? Some critics have concluded that the outcome of this review is already decided, and that the Secretary of State is not looking for a diagnosis, but for a pretext to enact long planned reforms to the healthcare service.  

Regardless of the tight timelines, we find ourselves at a potentially crucial turning point for the NHS, with this review – and the 10-year plan that will follow it – setting out the priorities the health service will be expected to adopt for years to come. It is encouraging, in this sense, that the review is expected to “shine a light on health inequalities and unwarranted variation in terms of demand for, access to, quality of and outcomes from NHS services across England.” The NHS Race and Health Observatory has been feeding evidence into the review in support of this vital focus. 

Ahead of the publication of Professor Darzi’s findings this September, we’ve highlighted some key considerations that this process needs to take account of if this review is to meaningfully advance the field of race and health.  

Data quality  

It’s vital that any assessment of performance considers how the NHS is performing for all communities, especially marginalised and ethnic minority communities. But we must first confront the fact that ethnicity recording in patient records is woefully incomplete and inconsistent, with almost 15% of records containing incorrect ethnicities. Until we fix this fundamental problem, there will always be a risk of bias and unwarranted variation in the NHS. Not only will this need to be carefully considered during the review itself, but the NHS must prioritise improving the collection and quality of ethnicity data, starting by renewing outdated guidance on data collection.  

Patient care  

There is ample evidence that racism affects patient care. This is well established for Black and ethnic minority staff and patients who directly experience racism, discrimination, and microaggressions in their everyday interactions with the NHS. These experiences erode trust and hamper outcomes among patients and, for members of the workforce who experience racism, there is an unavoidable knock-on effect on their ability to deliver high quality care. Racism also degrades quality of care for all patients, where worse access and poorer health outcomes for minoritised groups lead to greater costs and inefficient deployment of vital resources.  

The effects of structural racism are further evident in the lack of diverse participation in trials, vaccine uptake, and genetic research, which can subsequently limit optimal outcomes emerging from future advances in personalised medicine. More than this, the diminishing, cumulative ‘weathering’ impact of racism on our workforce needs be seriously considered in order that we can build an NHS that works for all of its staff and patients.  

Elective backlog 

A major area of contention in the general election campaign was the long and growing waiting lists for elective surgeries and other appointments. Professor Darzi’s review will rightly consider how these waiting lists got so long and how they might be cleared. It is, however, important that the review also acknowledges that these long waits are not distributed equally. Our evidence has shown that Asian and Black patients experienced longer delays across several procedures following the COVID-19 pandemic, with Asian groups experiencing an 8% overalll fall relative to White groups. For some procedures, this fall was as much as 23%.  

Not only do these figures reiterate the case for urgent action on waiting lists, but they also demonstrate the complexity of the NHS performance picture when we start to consider differential outcomes for racial and ethnic groups. This is the level of careful consideration and nuance that the Darzi review – and the subsequent 10-year plan – will need to contain if the government wants to build a truly fair health service. With a tight timeline for completion, it’s important that pace doesn’t get in the way of equity.