There have been many noble visions to save the NHS. Will this one be realised?

The NHS is in serious trouble. This is the considered diagnosis of Lord Darzi and this week's report into the NHS.

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Undertaken over just nine weeks, it is an astonishing piece of work and its commissioning underscores the new government's commitment to action on the NHS right from the beginning. It sets out in detail the steady decline in the health service over the past 15 years and thoroughly rejects the idea that this is purely a pandemic hangover.

It's a bleak read. Demand for the NHS has never been higher and yet performance across the board is shockingly poor.

Just a few highlights: two million people are waiting for community or mental health services, many of them children and almost 400,000 for more than a year; more than 300,000 people are waiting over a year for outpatient treatment - 15 times as many as in 2010; and nearly 10% of patients have to wait more than 12 hours to be seen in A&E, causing an estimated 14,000 unnecessary deaths a year.

State healthcare is like a staircase with emergency care at the bottom. For a patient with the frailty of chronic ill-health or old age to end up in A&E they must fall past numerous safety steps along the way. The first, and perhaps most important, is good social welfare to improve overall health and reduce poverty.

Next come public health measures for the primary prevention of illness, then reliable access to GPs and community care with rapid response services to treat illness before it progresses to hospital care.