LSE-Lancet Commission: Rebuilding the NHS Post-Pandemic

Dawn O'Shea

May 07, 2021

Post-pandemic, there is a historic opportunity to strengthen the NHS and improve health and care for all, according to a new London School of Economics and Political Science (LSE)-Lancet Commission on the future of the NHS.

The Commission, formed in 2017, brings together 33 leading research, policy, management and clinical experts from the four constituent countries. It is published alongside four health policy articles published in the  Lancet and the Lancet Digital Health.

The report warns against any further major reorganisation of the NHS, which would be disruptive and would fail to deliver the intended benefits. Instead, it argues for building on the common strengths of the NHS, with a focus on investment, integration of existing services and disease prevention, to improve health and care and reduce widespread inequalities.

The Commission points out that UK health care spending as a share of gross domestic product is lower than the G7 country average (10.3% vs 11.4% in 2019). This is compounded by relatively low levels of welfare spending (20.6% vs 23.3%). It calls for funding for the NHS, social care and public health be increased by at least 4 per cent per year in real terms over the next 10 years.

Alongside this long-term funding, the Commission recommends a one-off injection in social care spending and public health. It recommends increasing the means test point at which people have to pay for their own care from £23,250 to £100,000 and introducing a cap on care costs of £75,000.

Based on tax revenue before the pandemic, the report proposes raising personal income tax, national insurance and VAT contributions by 1p each by 2025-2026, and increasing personal income tax and national insurance to 2p by 2030-2031.

“Without concerted action and increased funding, we risk the UK falling further behind other high-income countries in health outcomes and life expectancy, continued deterioration in service provision, worsening inequalities, increased reliance on private funding, and an NHS that is poorly equipped to respond to future major threats to health,” warns co-research lead of the Commission, Dr Michael Anderson from the LSE). “The NHS is under our custodianship and we have a responsibility to current and future generations to secure its long-term survival.”

The Commission sets out seven policy recommendations:

1. Commit to annual increases in funding of 4 per cent in real-terms over the next decade, and additional funding for social care and public health.

2. Develop a ‘spending wisely’ framework to optimise resources.

3. Create a sustainable, skilled and fit-for-purpose workforce, coordinated on a UK-wide basis and tied into NHS and social care expenditure plans.

4. Strengthen cross-governmental action and earmark funding, and prepare to protect against major threats to health.

5. Enhance diagnostics and novel routes to diagnosis.

6. Enable the routine use of data, to learn from every patient encounter.

7. Improve integration, for example, strengthening primary care, removing the requirement to promote competition in England, and link electronic records.

Anderson M, Pitchforth E, Asaria M, Brayne C, Casadei B, Charlesworth A, Coulter A, Franklin BD, Donaldson C, Drummond M, Dunnell K, Foster M, Hussey R, Johnson P, Johnston-Webber C, Knapp M, Lavery G, Longley M, Clark JM, Majeed A, McKee M, Newton JN, O’Neill C, Raine R, Richards M, Sheikh A, Smith P, Street A, Taylor D, Watt RG, Whyte M, Woods M, McGuire A, Mossialos E. LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19. Lancet. 2021 May 6 [Epub ahead of print]. doi: 10.1016/S0140-6736(21)00232-4.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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