100 days after Darzi: A nurse’s perspective on transforming the NHS

With over twenty years of nursing experience, I’ve witnessed firsthand the challenges that define the NHS: mounting waiting lists, staff shortages, financial pressures, and an aging population demanding more personalised, high-quality care. These challenges are especially acute in the peri-operative pathway where I specialise, where inefficiencies disrupt surgical schedules, impact recovery, and strain already overstretched resources.

The 100 days since the Darzi report’s publication have offered time to reflect on these pressing issues and the opportunities for change. As the NHS faces record-breaking backlogs, inefficiencies in pre- and post-operative processes ripple through surgical care, exacerbating delays and impacting outcomes. The report not only highlights systemic problems but also presents a bold vision for digital transformation as a solution. Reflecting on its lessons, I’ve considered both the barriers and opportunities for improvement in the areas I know best.

Transformation in elective surgery

Lord Darzi offers a stark assessment of the pressures facing the NHS. I see daily how these challenges are impacting surgical care, where delays and resource constraints often lead to poorer patient outcomes and heavier workloads for clinicians. A critical call to action from the report is to modernise outdated processes and improve patient flow. Many surgical departments still rely on manual, paper-based systems that create bottlenecks, disrupt schedules, and waste valuable resources. With 7.57 million cases on the waiting list, the NHS faces mounting delays that are compounded by inefficiencies in the peri-operative pathway.

This is especially evident in areas like pre-operative preparation and post-operative recovery, where the lack of streamlined systems leaves patients waiting longer and clinicians struggling to manage demand. For example, in the pre-operative stage, reliance on outdated systems can result in missed or incomplete patient information, increasing the risk of complications and last-minute cancellations. Post-operatively, non-digitised systems hinder effective monitoring after discharge, leading to avoidable readmissions and slower recovery times.

Addressing these challenges requires a decisive shift toward digitisation. Solutions such as digital pre-operative assessments and virtual wards not only streamline workflows and reduce administrative burdens but also directly enhance patient safety and clinician effectiveness. By centralising patient information, enabling early risk identification, and supporting efficient care pathways, these tools tackle inefficiencies head-on. With waiting lists at an all-time high, implementing these changes is no longer optional, it is essential to safeguarding patient outcomes, alleviating clinician workloads, and building a resilient, patient-centred NHS.

SWLEOC: A digital success story

One particular hospital I work closely with is the South West London Elective Orthopaedic Centre (SWLEOC), which has become a national leader in addressing inefficiencies highlighted in the Darzi report. As one of Europe’s largest joint replacement centres, SWLEOC demonstrates how targeted digital solutions can directly address systemic issues, transforming surgical care and improving outcomes for both patients and clinicians.

In 2019, SWLEOC introduced a digital pre-operative assessment, allowing patients to submit their health information remotely. This innovation transformed the pre-op process, enabling many patients to be assessed, deemed ready for surgery, and booked in within just two days, a significant improvement from the previous three- to four-week timeline. Building on this success, SWLEOC adopted a virtual ward solution to optimise post-operative care. Over a three-month period, 93% of patients were transitioned to Patient-Initiated Follow-Up (PIFU) pathways, freeing up 520 consultant clinic slots annually and generating £56,000 in financial savings. This efficiency enabled 12 clinic sessions to be converted into theatre sessions, resulting in 35 additional surgeries during the same period. These innovations have not only improved patient outcomes but have also been recognised as a model for outpatient transformation by NHS England/GIRFT.

SWLEOC’s achievements have earned national recognition, including numerous industry awards. These accolades validate the transformative potential of digital tools to streamline surgical care, improve efficiency, and enhance patient satisfaction. By demonstrating how digital innovation can address the challenges outlined in the Darzi report, SWLEOC provides a powerful blueprint for other healthcare providers striving to modernise their peri-operative pathways.

Barriers to adoption

Digital transformation holds immense potential to modernise peri-operative pathways, but three key barriers continue to slow its adoption. Addressing these challenges is essential to unlocking the full benefits for patients and clinicians alike. Here’s what stands in the way and how we can overcome it:

• Cultural resistance to change
  Many clinicians are understandably hesitant about new tools, fearing they may disrupt workflows or add to already overwhelming workloads. This hesitation, though valid, can delay the adoption of solutions designed to ease these very pressures. To break through this resistance, healthcare leaders must actively involve staff at every stage - design, implementation, and evaluation. By demonstrating how digital tools improve care quality and reduce workload, we can build trust, foster innovation, and empower clinicians to champion change.
  
  

• Outdated legacy systems
  Legacy infrastructure continues to hinder the NHS's ability to implement modern digital tools. Outdated systems often cannot integrate seamlessly with new technologies, creating bottlenecks and inefficiencies that frustrate clinicians and disrupt patient care. The solution lies in investing in interoperable systems that connect effortlessly with existing frameworks, reducing inefficiencies and enabling more effective care delivery. This isn’t just about upgrading technology; it’s about creating a foundation for sustainable, long-term transformation.
  
  

• Underinvestment in infrastructure and training
  Without proper funding and comprehensive training, even the most advanced systems risk poor uptake. This is particularly true in surgical care, where confidence in digital tools is critical. Training programmes must go beyond technical know-how, focusing on why these tools matter, how they improve patient outcomes, and how they ease clinician workloads. With the right investment in infrastructure and ongoing support, we can ensure that digital transformation is both impactful and sustainable.

The way forward

The Darzi report is a call to action, urging the NHS to tackle its challenges with bold, innovative solutions. Over the past 100 days, it has provided an opportunity to reflect on critical lessons: the need to modernise processes, embrace digital tools, and foster collaboration and innovation. Acting on these lessons is essential to empowering clinicians, enhancing patient care, and freeing vital resources to meet growing demands. The success of SWLEOC highlights the transformative impact of combining innovation with collaboration, offering a model that others can follow.

With a new 10-year health plan for the NHS under way, there is an opportunity to align these lessons with long-term strategic goals. By investing in interoperable systems and equipping clinicians with training and support, the NHS can turn the vision of a digital-first healthcare system into reality. As a nurse, I believe we stand at a pivotal moment. With the right commitment and focus, digital transformation can define the future of healthcare for patients, staff, and society. The Darzi report offers a clear blueprint, it’s now up to us to act decisively and deliver on its vision.