Over the last few days there have been many commentators, my organisation included, who have said that this week’s Darzi report is not shocking or surprising, but it is still troubling.
I wanted to look at that a bit more closely. Why is it so important – and increasingly I think it is – when those of us within think tanks, academia and indeed working in the service have also been saying “well yes, we know those figures, in fact we put that graph or that information to the Darzi review team ourselves”.
How can something be simultaneously so broadly already understood and yet simultaneously so seminal and crucial?
The importance of reflective listening
To understand that, I have turned to the literature on reflective listening – the core skill within any therapeutic relationship and a crucial skill in counselling for several reasons.
Validation and empathy: Reflecting back shows clients that their feelings and experiences are being heard and understood. This validation helps build trust and rapport between the counsellor and the client. The Darzi report, while full of the ‘coolness’ of statistics, charts and graphs, is fundamentally rooted in a desire to listen and validate the experience of those working in and receiving the service of the NHS. Of course, it could have gone further with time to genuinely listen to front-line staff, leaders and with patients and carers, but it was done in nine weeks. Nevertheless, the figures about pressures on the service – about waiting times, about regulation, about staff experience – they form a context of validation and empathy.
Clarification: It ensures that the counsellor accurately understands the client’s message. If there is any misunderstanding, the client can correct it. The Darzi report isn’t perfect, and it isn’t complete. We have raised concerns that the terms of reference didn’t allow the team to fully explore social care (adult and children’s), or the complexities and the challenges with the huge cuts in the public health budget. Both, however, are mentioned, and there is room in the coming months for further conversation and clarification as the 10-year plan develops. It should create that space.
Emotional awareness: Reflecting back helps clients become more aware of their own emotions and thoughts. This increased awareness can lead to deeper self-understanding and insight. I think the Darzi report has been a process of group therapy. For many in the service, and it is only a year ago that I was a trust CEO, these figures presented so starkly, comprehensively and accurately say at a deeper level that “I see you”. In any system, from a single family to the whole NHS, we need to be seen and understood before we can start the process of change or possibly even the Prime Minister’s call of “reform”.
Encouragement to explore: By reflecting, counsellors encourage clients to explore their feelings and thoughts more deeply. The Darzi report opens the proverbial Pandora’s box – letting out all the difficult, challenging experiences the NHS finds itself in. In the original myth, Pandora also finds hope in the box, which she quickly bottles again. The story explains this is the reason for humanity’s continued hope within a context of suffering. Many who have been putting these charts and figures out for many years, or working in the service feeling ignored, overlooked and glossed over, can experience a collective sigh of relief. The government have owned them. There is now an important moment to really seize this chance to explore.
Reflective listening is at the root of all good relationships and an important anchor in creating strong alliances. One of my teachers used to tell me I had two ears and one mouth for a reason – to listen twice as hard as I spoke. I think the Darzi report has listened hard. It isn’t complete, but it is emotionally intelligent, and that is its power.
Suggested citation
Stein T (2024) “Why is the Darzi report so important?”, Nuffield Trust blog