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Sir Keir Starmer will warn the NHS must “reform or die”, as the government publishes an independent investigation into the state of the health service.

The report – ordered by Health Secretary Wes Streeting days after he took on the role – was carried out by peer and surgeon Lord Darzi.

Politics live: Starmer and Sunak face off again over winter fuel

It will conclude the NHS is in a “critical condition”, with record waiting lists and too much of its budget spent in hospitals, as well as saying the nation’s health had significantly deteriorated over the past 15 years.

However, Lord Darzi will also say the service’s vital signs “remain strong”, as the sector is filled with staff who “shared passion and determination to make the NHS better for our patients”.

In a speech on Thursday, the prime minister will point to the probe’s findings and lay the blame at the Conservatives’ door – especially the impact of their 2012 Health and Social Care Act, which the report described as a “calamity” that had “proved disastrous”, as well as claims there has been a decade of underinvestment.

But he will offer his own solutions, with a 10-year plan from Labour that promises to have “the fingerprints of NHS staff and patients all over it”.

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Sir Keir will say: “Our NHS went into the pandemic in a much more fragile state. We had higher bed occupancy rates, fewer doctors, fewer nurses and fewer beds than most other high income health systems in the world.

“And let’s be clear about what caused that… a ‘scorched earth’ approach to health reform, the effects of which are still felt to this day.

“The 2010s were a lost decade for our NHS… which left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow.”

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Minister’s plan to cut NHS waiting list

The prime minister will say there is a “profound responsibility” on the government to address the issues, for both health and economic reasons, promising three “big shifts” in its approach:

• Using more technology to create a “digital NHS”
• Shifting more care out of hospitals and into communities
• Moving from treating sickness to focusing on prevention

Sir Keir will warn that what he calls “the biggest reimagining of our NHS since its birth” will not be “easy or quick”.

But he will add: “What we need is the courage to deliver long-term reform – major surgery not sticking plaster solutions.

“The NHS is at a fork in the road, and we have a choice about how it should meet these rising demands – raise taxes on working people to meet the ever-higher costs of aging population, or reform to secure its future.

“We know working people can’t afford to pay more, so it’s reform or die.”

Report gives Starmer mandate for change

Lord Darzi’s damning report coincides with the publication of the NHS monthly performance data.

The figures will reinforce what the former health minister has laid bare in his blistering assessment of the health service. From A&E to children’s services, mental health to cancer treatment, his conclusion is that patients are being failed.

It is in this state because the NHS has suffered from consecutive body blows – years of chronic underfunding, a growing population with complex health needs and the impact of the pandemic. This should come as no surprise.

The slow, steady decline of the NHS has been evident for some time. The challenge facing the government is its response.

What does it do now? Lord Darzi recommends three key areas for urgent action: NHS reform that will see a shift away from hospitals towards primary care and community-based services, tackling the NHS estate, and utilising developing technology to improve patient care.

The government has already said it is going to prioritise the longest waits on the elective register. But should it do that while ignoring the root causes as outlined in the report?

There is the danger then that targets will continue to be missed in the mid to longer term.

The challenge facing the government is it does not have time to waste or money to spare. It is evident that fixing the NHS will need both.

Lord Darzi says there is no quick fix and it is likely the prime minister knows already what action must be taken first.

He knows too, that this report gives him a mandate for transformative and desperately needed change.

Shadow health secretary Victoria Atkins said the Tories would “review this report carefully”, but claimed Labour had appeared to have “missed an opportunity to put together meaningful plans for reform”.

She added: “We Conservatives recognise that investment has to be married with reform. This is why we brought forward long-term plans for productivity, tech, ‘Pharmacy First’, virtual wards, attracting pharmaceutical research and training and retaining staff. We did this whilst boosting investment in the NHS in real terms every single year.

“The Labour government will be judged on its actions. It has stopped new hospitals from being built, scrapped our social care reforms and taken money from pensioners to fund unsustainable pay rises with no gains in productivity. They need to move from rhetoric to action.”

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Liberal Democrat leader Sir Ed Davey, who campaigned heavily on health and social care during the last election, said the report’s findings showed the NHS was “on its knees after years of the Conservatives driving local health services into the ground”.

He said fixing the problem was “this country’s greatest challenge”, as he called for the government to “make it their top priority”, adding: “That must include recruiting more GPs, fixing our crumbling hospitals and crucially tackling the social care crisis that has been ignored for far too long.”

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Protesters throw powder on Tower Bridge during London Marathon

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Protesters throw powder on Tower Bridge during London Marathon

Two pro-Palestinian demonstrators have thrown red powder on Tower Bridge – just moments before leading runners in the London Marathon went past.

The protesters were arrested on suspicion of causing a public nuisance and remain in custody, said the Metropolitan Police.

A video shared by Youth Demand, which is calling for a trade embargo on Israel, shows two people jumping over a barrier that separates spectators from the race course.

The pair, wearing t-shirts that say “Youth Demand: Stop Arming Israel”, are then seen standing in the middle of the road on the bridge.

Pic: LNP
Image:
Pic: LNP

They throw red powder in the air as an official marathon car goes past displaying the race time.

A motorbike with a cameraman on board continues along the route, while a second motorbike stops and one of the riders gets off and pushes the pair out of the way, just before the men’s elite runners pass.

Several police officers then jump over the barrier and detain the pair, the footage shows.

More on London Marathon 2025

There appeared to be no impact on the marathon.

More than 56,000 participants were expected to take part in the 26.2-mile race through the capital.

Sabastian Sawe of Kenya won the men’s elite race in a time of two hours, two minutes and 27 seconds, while Ethiopia’s Tigst Assefa shattered the women’s-only world record in two hours, 15 minutes and 50 seconds.

Assefa beat the previous best of two hours, 16 minutes and 16 seconds set last year in London by Kenyan Peres Jepchirchir.

Read more:
Sky’s Beth Rigby running marathon in honour of ‘dearest friend’
Badenoch does not rule out local coalitions with Reform

Pic: LNP
Image:
Pic: LNP

The Metropolitan Police said in a statement: “At around 10.38am, two protesters from Youth Demand jumped over barriers at Tower Bridge and threw red paint on to the road.

“Marathon event staff intervened to remove the protesters from the path of the men’s elite race which was able to pass unobstructed.”

The force added that they were “quickly supported by police officers who arrested the protesters on suspicion of causing a public nuisance”.

The Met said the paint “appeared to be chalk-based” and was not expected to “present a hazard to runners yet to pass this point”.

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Kemi Badenoch does not rule out local coalitions with Reform after next week’s council elections

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Kemi Badenoch does not rule out local coalitions with Reform after next week's council elections

Kemi Badenoch has not ruled out forming coalitions at a local level with Reform after the council elections next week.

Speaking to Sunday Morning with Trevor Phillips, the Conservative leader did however categorically rule out a pact with Nigel Farage’s party on a national level.

“I am not going into any coalition with Nigel Farage… read my lips,” she said.

However, she did not deny that deals could be struck with Reform at a local level, arguing that some councils might be under no overall control and in that case, “you have to do what is right for your local area”.

“You look at the moment, we are in coalition with Liberal Democrats, with independents,” she said. “We’ve been in coalition with Labour before at local government level.

“They [councillors] have to look at who the people are that they’re going into coalition with and see how they can deliver for local people.”

She added: “What I don’t want to hear is talks of stitch-ups or people planning things before the results are out. They have to do what is right for their communities.”

More on Electoral Dysfunction

A total of 23 councils are up for grabs when voters go to the polls on Thursday 1 May – mostly in places that were once deemed Tory shires, until last year’s general election.

It includes 14 county councils, all but two of which have been Conservative-controlled, as well as eight unitary authorities, all but one of which are Tory.

Ms Badenoch has set expectations low for the Tories, suggesting they could lose all the councils they are contesting.

The last time this set of councils were up for election was in 2021, when the Conservative Party was led by Boris Johnson who was riding high from the COVID vaccine bounce.

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Counter-terrorism police investigating after two women injured in Leeds

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Counter-terrorism police investigating after two women injured in Leeds

Counter-terrorism police are investigating after an incident involving a crossbow and a firearm left two women injured in Leeds.

Police were called to Otley Road at 2.47pm on Saturday to reports of a “serious incident involving a man seen with weapons”, West Yorkshire Police said.

Officers arrived at the scene to find two women injured – and a 38-year-old man with a self-inflicted injury. All three were taken to hospital, with the man held under arrest, but their injuries are not believed to be life-threatening.

“Two weapons have been recovered from the scene, which were a crossbow and a firearm,” Counter Terrorism Policing North East said in a statement.

The incident happened on the ‘Otley Run’ pub crawl, with one venue saying it was closed for the evening due to “unforeseen circumstances”.

Officers guard one of the crime scenes in Leeds
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Officers guard one of the crime scenes

Officers inside the cordon in Leeds
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Officers inside the cordon in Leeds

Counter Terrorism Policing’s statement added: “Due to the circumstances surrounding the incident, Counter Terrorism Policing North East have taken responsibility for leading the investigation with the support of West Yorkshire Police.

“Extensive enquiries continue to establish the full circumstances and explore any potential motivation.”

Home Secretary Yvette Cooper described it as a “serious violent incident” and said she was being kept updated by police.

“Thank you to the police and emergency services for their swift response,” she said. “My thoughts are with the victims and all those affected by this attack.”

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