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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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UK weather: Scottish hamlet reaches -18C in coldest January night in 15 years

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UK weather: Scottish hamlet reaches -18C in coldest January night in 15 years

Temperatures in a hamlet in northern Scotland fell to -18.7C (-1.66F) overnight – the UK’s coldest January night in 15 years, the Met Office has said.

Altnaharra, in the northern region of the Highlands, reached the lowest temperature while nearby Kinbrace reached -17.9C (-0.22F).

It is the coldest January overnight temperature since 2010, when temperatures dropped below -15C several times at locations across the UK, including -22.3C (-8.14F) on 8 January in Altnaharra.

Forecasters had previously said there was a very small probability it could reach -19C.

A Highland cow grazes in a snow-covered field near Shotts, North Lanarkshire. Temperatures will continue to fall over the coming days, with the mercury potentially reaching minus 20C in northern parts of the UK on Friday night. Weather warnings for ice are in place across the majority of Wales and Northern Ireland, as well as large parts of the east of England. Picture date: Friday January 10, 2025.
Image:
A Highland cow grazing near Shotts, North Lanarkshire. Pic: PA

Met Office meteorologist Alex Deakin said: “Friday night into Saturday morning may well be the nadir of this current cold spell.”

Temperatures for large parts of the UK are set to fall again as the cold weather continues.

St Andrew's church, Kiln Pit in Durham Pic: PA
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St Andrew’s church at Kiln Pit in Durham. Pic: PA

Met Office meteorologist Zoe Hutin said: “We’ve still got tonight to come, and tomorrow (Saturday) night could also be chilly as well.

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“Temperatures for tomorrow night, it will be mainly eastern parts that see temperatures dropping widely below freezing, so East Anglia, the northeast of England, northern and eastern Scotland as well.

“So another chilly night to come on Saturday, but then as we go into Sunday and into Monday, then we can start to expect temperatures to recover somewhat.

“I won’t rule out the risk of seeing something around or just below freezing again on Sunday night into Monday, but it won’t be quite so dramatic as the temperatures that we’re going to experience as we go overnight tonight.”

Ugo Sassi from Cambridge skates on a frozen flooded field in Upware, Cambridgeshire. The Cambridgeshire Fens were the birthplace of British speed skating and require four nights of frost, with a temperature of -4 or colder and little or no thawing during the days in between, to make ice strong enough to skate on. Temperatures will continue to fall over the coming days, with the mercury potentially reaching minus 20C in northern parts of the UK on Friday night. Weather warnings for ice are in pla
Image:
Skating on a frozen flooded field in Upware, Cambridgeshire. Pic: PA

On Monday, temperatures are expected to be more in line with the seasonal norm, at about 7C to 8C.

A family walk across Hothfield Common in frosty conditions near Ashford in Kent.
Pic: PA
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A family walk across Hothfield Common in frosty conditions near Ashford in Kent. Pic: PA

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The freezing conditions have led to travel disruption, with Manchester Airport closing both its runways on Thursday morning because of “significant levels of snow”. They were later reopened.

Transport for Wales closed some railway lines because of damage to tracks.

Hundreds of schools in Scotland and about 90 in Wales were shut on Thursday.

Meanwhile, staff and customers at a pub thought to be Britain’s highest were finally able to leave on Thursday after being snowed in.

The Tan Hill Inn in Richmond, North Yorkshire, is 1,732 feet (528m) above sea level.

Six staff and 23 visitors were stuck, the pub said on Facebook.

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Government contract ends for controversial asylum barge Bibby Stockholm

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Government contract ends for controversial asylum barge Bibby Stockholm

The government contract for the controversial asylum barge in Dorset has ended.

The last asylum seekers are believed to have left Bibby Stockholm at the end of November after Labour said it would have cost more than £20m to run in 2025.

Its closure this month was expected, and on Friday the management firm and the Home Office confirmed to Sky News the contract had now expired.

It’s currently unclear when Bibby Stockholm will leave Portland and what it will be used for next.

The Conservative government started using the vessel in August 2023.

It said putting nearly 500 men on board while they waited for an asylum decision was cheaper than paying for hotel rooms.

However, it was controversial from the start and sparked legal challenges and protests.

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Days after the first group boarded there was an outbreak of Legionella bacteria in the water system and it had to be evacuated for two months.

In December 2023, an Albanian asylum seeker, Leonard Farruku, died on board.

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A Home Office spokesperson said the government was determined to reform the asylum system to make it operate “swiftly, firmly and fairly”.

“This includes our accommodation sites, as we continue to identify a range of options to reduce the use of hotels,” the new statement added.

“We are already closing some hotels and will continue to engage with local authorities and key stakeholders as part of this process.”

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How is your local NHS coping under winter pressures?

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How is your local NHS coping under winter pressures?

Pressure on hospitals is particularly high this winter, with more than a dozen declaring critical incidents in recent days.

Hospitals struggle every winter with additional pressures due to the impact of cold weather, but the early arrival of flu this season and high volume of cases meant Christmas and New Year’s weeks were even busier than usual.

There are currently at least 20 hospitals that have declared critical incidents in England, although this is a fast-moving picture, and some trusts will go into critical incident for as little as half an hour.

The latest NHS winter situation reports give a more detailed look at the level of pressure experienced by individual trusts, including those with the worst ambulance handover delays and highest levels of flu patients.

Ambulance handover delays

When a patient arrives at a hospital in an ambulance, clinical guidelines suggest that it should take no longer than 15 minutes to transfer them into emergency care.

It is now common for handovers to regularly exceed this timeframe, however, when emergency departments are overcrowded and lack the capacity to keep up with new patient arrivals.

This is risky for patients because it delays their assessment and treatment by clinicians, and also reduces the availability of ambulances to respond to new incidents.

The trust with the longest delays was University Hospitals Plymouth, with an average handover time of three hours and 33 minutes over the week – two hours and 40 minutes longer than the average for England. It also recorded the longest average handover times for a single day, at five hours and 14 minutes on New Year’s Day.

Use the table below to search for local ambulance handover times:

On 7 January, University Hospitals Plymouth declared a critical incident at Derriford Hospital due to “significant and rising demand for hospital care”, though this has since been stood down.

The Shrewsbury and Telford Hospital Trust had an average ambulance handover time of three hours and 15 minutes, increasing by more than an hour from one hour and 51 minutes the week before.

In Royal Cornwall Hospitals NHS Trust, 83% of handovers took more than 30 minutes, the highest share among areas dealing with more than five ambulance arrivals per day.

This area also recently declared and then stood down a critical incident.

In total across England, 43 trusts out of 127 had average handover times of more than an hour, while nine areas had average handover times of more than two hours.

Flu

This winter’s flu wave arrived earlier than usual and has hit health services hard.

Over New Year’s week, there were 5,407 flu patients in hospitals in England on average each day, more than three times higher than during the same week last year and increasing by 20% from the week before.

The worst impacted trusts were Northumbria Healthcare and University Hospitals Birmingham, with 15% and 13% of all available beds occupied by flu patients respectively in the latest week.

Wirral University Teaching Hospital NHS Foundation Trust had among the biggest increase in flu patients from the previous week, more than doubling from 18 to 42 patients per day on average.

Use the table below to search for local flu hospitalisations:

There are some indications that flu activity may have now peaked, with national flu surveillance showing a decrease in positive flu tests in the latest week, though activity remains at high levels.

Bed occupancy

Current NHS guidance is that a maximum of 92% of hospital beds should be occupied to reduce negative risks associated with overfilled beds.

These risks include the impact on patient flow resulting from it being more difficult to find beds for patients, and negative impacts on performance and waiting times, as well as being linked to increased infection rates.

In the week to 5 January, 92.8% of 102,546 open hospital beds were available each day on average, not far off the recommended level.

However, bed occupancy was very high in some trusts, with more than 95% of beds occupied in 43 trusts on average over the week.

The trust with the highest rate of bed occupancy was Wye Valley NHS Trust, with 99.9% of 332 beds occupied on average throughout the week.

There was only one day when beds weren’t fully occupied, on 3 January, when two beds of 322 were available.

Use the table below to search for local bed occupancy:

Kettering General Hospital NHS Trust recorded bed occupancy of 98.5% over the week. This trust declared a critical incident on 8 January.

Part of the problem for bed availability is prolonged hospital stays – also known as bed-blocking.

This is often linked to pressures in other parts of the health and social care system, for example when patients can’t be discharged to appropriate social care providers even though they are ready to leave hospital.

Just under half of beds occupied by patients in English hospitals last week were occupied by long-stay patients who had been there for seven or more days.

In seven trusts, at least three in five beds were occupied by long-stay patients, while in Barking, Havering and Redbridge University Hospitals NHS Trust the figure was more than four in five beds.


The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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