Lord Darzi’s 2008 report: ‘High Quality Care for All –the NHS next stage review’, opened a new chapter on quality in the English NHS. It acted as the driving force for the NHS to move on from a regime of performance management, which focused on driving activity, to one that took a more holistic view of patient care and aimed to deliver higher quality services. After 10 years, Lord Darzi, alongside think-tank IPPR, conducted another report, to examine the developments that had been made in terms of quality, and to make recommendations for future funding and organisation of the NHS. The ten-year period between these two reports saw the NHS go through one of the most radical transformations and leanest funding regime in its history. As such, the report was aimed at not only demonstrating the advances made in quality, but to give an objective answer to the funding requirements of the NHS by 2030.  
CF was asked to join the advisory panel, which contributed key information to the report, as well as helped to set the parameters of what should be considered. Additionally, CF were asked to join with IPPR as the analytics partner on the report. As analytics partner, the role of CF was dual: 

  • To review all main measures of quality and performance within the NHS and to identify their variation over the last decade.  
  • To assess the future funding requirement of the NHS –identifying the equivalent productivity requirement under a number of different scenarios. 


This work acted as the basis for the interim report and would also inform the recommendations for how the NHS should be reformed in future. CF were uniquely placed to lead this work, combining NHS leadership experience with first-class NHS capability and the ability to test assumptions with leading academics within the industry.  
The team were able to identify a compelling case that over the last 10 years, there had been three dominant trends:  


  1. Quality has improved almost universally, with patients receiving care that produced better outcomes, fewer cases of patient harm and generally an improved experience. Conversely, the public satisfaction with the NHS has decline. 
  2. This was attributed to a dramatic decline in ease-of access and performance within the NHS. Headline targets, such as the 4-hourA&E standard had deteriorated, and patients were waiting longer to get treated. 
  3. The decline in access was attributed to the observed funding ‘squeeze’, which saw the rate at which NHS funding was increased decrease well below the long-run historic average. 


The most pivotal element of the work was setting a clear an unambiguous case for the increase in funding. To do this we undertook robust modelling of historical and demographics, activity, and costs and funding levels and built a detailed forecast model. We confirmed the approach with the lead economist for all major think tanks as well as the finance director of the NHS. We then synthesised the results and communicated them in a clear and succinct way. Working with the IPPR team we then consider how to use the results to have maximum impact in their dissemination.


The results of the work generated significant headlines and were—according to the Secretary of State for Health and the NHS Chief Executive—instrumental in securing a new settlement of 3.4% for the NHS.
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“I wanted to send a note to say a very big thank you for all your fantastic work on the Review. It was an excellent piece of work—a powerful synthesis of what happened and really robust and serious numbers on what the NHS needs for the future.  
We secured great coverage that will really help to influence the debate as the Government gears up for an announcement on funding on the 70th anniversary. See below for the links to the news stories. Thank you also to David for going on the Today Programme and speaking in the Lords debate.  
Matthew Swindells called me to say how helpful it had been, and that it was discussed at the NHSE Board Away Day; Jeremy Hunt was pleased with the report and said it was helpful; the Shadow Health Secretary Jon Ashworth put out a very supportive statement; and the Shadow Chancellor said it was useful to have a realistic assessment of the funding required. All in all, it landed about as well as any of us could have hoped.  
I’ve also heard that the Government are seriously considering the possibility of legislative change for the health service. There is a debate at the domestic policy subcommittee that is ongoing. So there may in fact be more scope for our proposals to be implemented more quickly than we had hitherto believed. I’ve been invited to meet with the No10 Chief of Staff and James Kent on Monday and will report back on what I hear from that meeting.  
It’s been a terrific result, and it’s been really fun to work together.“ 


We won the MCA award for thought leadership in 2019 for this work.