Long delays for hospital, GP and mental health services are leading to thousands of unnecessary deaths and have ruptured “the social contract between the NHS and the people”, an inquiry has concluded. The findings of the study by Lord Ara Darzi, commissioned by Labour when it came to power, will be cited by the prime minister, Keir Starmer, who will on Thursday warn that the NHS has to “reform or die”. In his detailed analysis of the NHS’s woes and path to recovery, Darzi warns the prime minister that it will take his government longer than the five years Labour promised before the election to get treatment waiting times back on track. He has estimated privately that the task will take “four to eight years”. Darzi says: “I have no doubt that significant progress will be possible, but it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term.” Starmer is to use a big speech on the NHS to rule out tax rises as a way of finding the extra billions of pounds that experts say the health service needs. The 142-page report by Darzi, a cancer surgeon andhealth minister under Gordon Brown, is a damning critique of how years of neglect of the NHS by previous governments have left it “in critical condition” and no longer able to give patients the timely care they need amid an explosion in demand caused by the UK’s ageing, growing and increasingly sick population. Darzi’s scathing indictment of the Conservatives’ 14-year stewardship of the NHS says that A&E is in “an awful state”. He cites evidence he received from the body representing A&E doctors that “long waits are likely to be causing an additional 14,000 more deaths a year – more than double all British armed forces combat deaths since the health service was founded in 1948”. He details how the NHS experienced three shocks during the 2010s: austerity funding under the Conservative-Liberal Democrat coalition government; Andrew Lansley’s “disastrous” reorganisation; and the arrival of Covid – the first two of which were “choices made in Westminster”. In his response, Starmer will accuse the consecutive Conservative administrations from 2010 to July 2024 of inflicting “unforgivable” damage on the NHS, including avoidable deaths due to long waits for A&E care. But he will also seek to reassure voters that the service will improve as a result of a 10-year plan to revive its fortunes, which Labour is expected to unveil early next year. The prime minister will promise “long-term health reform – major surgery, not sticking-plaster solutions”. He will also outline a future in which a lot of care is moved out of hospitals and into community-based services and there is a determined drive to tackle the rise in the number of people with long-term conditions, such as diabetes, heart disease and lung problems, through better prevention measures. Darzi’s report also found that: The number of people forced to wait more than a year for hospital treatment which they should get within 18 weeks has risen 15-fold since March 2010, from 20,000 to more than 300,000. Improvements in survival from cancer “slowed substantially during the 2010s”. The quality of care in some key areas, such as maternity services, is now a real concern. Despite having more staff and a record budget, the NHS is less productive than before because so many buildings are so old and the NHS has been “starved” of capital funding. Many staff have become “disengaged” since Covid and are now doing much less discretionary extra work. The state of the under-resourced social care sector is “dire” and is placing “an increasingly large burden on families and on the NHS, with a profound human cost and economic consequences”. Ed Davey, the Liberal Democrat leader, said: “This report shows the NHS is on its knees after years of the Conservatives driving local health services into the ground.” Fixing the health service “is this country’s greatest challenge”, he added. Starmer is under growing pressure for his government, already facing tough decisions over public spending, to find extra resources to boost the NHS’s recovery. Thea Stein, the chief executive of the Nuffield Trust thinktank, urged Rachel Reeves to use her first budget next month to plug a multibillion-pound hole in NHS England’s spending this year. The Treasury is undertaking a multi-year spending review due to report in spring 2025. But the level of overall public-sector spending pencilled in for the next parliament would currently mean a similar level of cuts to those seen under David Cameron’s austerity government. Reeves has already announced a delay to the Conservatives’ new hospital programme, which was a pledge to build or expand 40 NHS hospitals by 2030, citing the £22bn fiscal black hole left by the previous government. In his speech, Starmer will categorically rule out increasing direct taxes to boost the NHS’s budget. The Health Foundation has estimated that the NHS in England alone will need an additional £46bn by 2029. Starmer will also say: “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 the ageing population, or reform to secure its future. We know working people can’t afford to pay more, so it’s reform or die.”