By Gabriel Princewill And Charlotte Webster
Researchers from the London School Of Economics (LSE) have authoured the Lancet Commission, setting out a long-term vision for the National Health Service (Nhs), which relays the foundations for a fairer health and care service.
The group made seven recommendations spanning workforce, disease prevention, diagnosis, digital health, and better integration of public health and social care.
Whilst on the one hand praising the Nhs for its comparatively high international standards, the prominent health experts also decried its recent failings, which they attributed to a shortage of financial resources.
Addressing the financial changes faced by the system is paramount, if the Nhs it to operate optimally, they collectively opined.
The researchers further called for annual increases in funding for the NHS, social care, and public health of at least 4% in real terms over the next decade. The specific quantification of a 4% increased funding increase is indicative of the degree of the money that needs to be pumped into the health service in their assessment.
Failure to take action risks a continued deterioration in service provision, worsening health outcomes and inequalities, and an NHS that is poorly equipped to respond to future major threats to health, they added.
Representatives from the London School Of Economics told The Eye Of Media.Com: ”The study conducted was done by some of the best minds in the field in the UK. This is how serious it has got, and action needs to be taken really soon in order not to predispose the nation’s health to a potentially disastrous outcome”
Opportunity
The Commission pointed to a historic opportunity to strengthen the NHS and improve health and care for all”.
The report is the first comprehensive analysis of the initial phases of the COVID-19 response, which highlights the main opportunities and challenges facing the NHS.
The Commission said a wide spread analysis highlights how far the health of the UK population lags behind that of other high-income countries, while also implying that the Nhs is erroneously held up as a leading example of universal health globally.
The authors pointed to comparatively low funding for the health service, as well as the long-standing impact of poorly resourced social care and public health programmes on the health of the nation, driving inequalities, and leaving the NHS poorly placed to pick up the pieces.
Formed in 2017, The Commission brings together 33 leading research, policy, management, and clinical experts from the four constituent countries of the UK.
Its recommendations were published alongside four health policy papers published in The Lancet and The Lancet Digital Health, and an editorial from The Lancet.
Warning Against Further Re-organisation Of Nhs
The report warns against any further major reorganisation of the NHS, which would be disruptive and 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.
Among the Commission’s key recommendations was a call to increase funding via the avenue of increased taxation, to help support resource management, recruiting and retaining staff, disease prevention, improving early diagnosis.
It also called for a sustained improvement in care, and improving integration between health, social care and public health.
Co-research lead of the Commission Dr Michael Anderson from the London School of Economics and Political Science (LSE), UK said: “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”.
“The NHS is under our custodianship and we have a responsibility to current and future generations to secure its long-term survival.”
“For many decades the NHS was the envy of the world, and it remains one of the most comprehensive and equitable healthcare systems in the world. Commission co-chair Professor Elias Mossialos from LSE, UK said.
Commission co Chair: Professor Elias Mossialos Image:lse.ac.uk
Commission co-chair Professor Elias Mossialos from LSE, UK.said that for the NHS to be truly the envy of the world again, politicians will need to be honest with the public that this will require increased taxation to meet the funding levels of other comparable high-income countries”, Commission co-chair Professor Elias Mossialos from LSE, UK.
“Given the major role of social circumstances in health inequalities, such as housing, employment, education and environment, it is crucial that this extra funding for the NHS and social care doesn’t come from cuts to other public services and welfare budgets.”
Erosion Of Social Care
Highlighting the NHS as a leading example of universal health coverage, let down by the erosion of social care and public health, co-chair of the Commission Professor Alistair McGuire from LSE, UK revealed two faces of the National Health Service.
He said: “The NHS has been a world leader for universal health coverage for over 70 years, providing care based on need, not ability to pay, for over 66 million people from cradle to grave”, says co-chair of the Commission Professor Alistair McGuire from LSE, UK.
“It was envisioned as one element of a comprehensive welfare system, but decades of costly reorganisations, years of austerity, extreme cuts in funding to social care, and an erosion of public health capacity have widened inequality and left the NHS under-resourced and ill-prepared for the COVID-19 pandemic.”
Co chair of Commission: Alistair Mcguire
The experts credited health and care workers for responding with outstanding skill and dedication; the innovation in understanding treatments, vaccines, and mobilising the vaccination programme; the way hospitals worked together to expand critical care capacity; and the rapid expansion of remote consultations.
Chronic Weaknesses
The Commission said the events of the past year have also exposed chronic weaknesses in the NHS, including poor coordination between sectors (eg, discharging people with undiagnosed COVID-19 from hospital to care homes), chronic underfunding, a fragmented public health service, and ongoing staffing shortfalls that pose a threat to the delivery and quality of care, particularly within primary care and mental health services.
They said the UK had one of the highest deaths in the world, whether directly attributable to Covid-19 or i terms of excess mortality.
Co-research lead Dr Emma Pitchforth from the University of Exeter, UK.
“During the pandemic, the NHS has struggled in the face of poor decision making by government, including delayed implementation of social distancing measures, poor coordination with local authorities and public health teams, a dysfunctional track and trace system, and a lack of consultation with devolved nations”, says co-research lead Dr Emma Pitchforth from the University of Exeter, UK.
She continues: “Staff morale is at rock bottom because of real term pay cuts and the relentless workload, and the pandemic will leave a challenging legacy of additional mental health needs, a growing backlog of people waiting for elective care, and extra support needed for those living with the after-effects of COVID-19. The pandemic has also laid bare stark socioeconomic and racial inequalities in the UK, and the catastrophic consequences for health.
Co Researcher :Dr Emma Pitchforth
Despite seven decades of universal free health care, improvements in life expectancy have slowed markedly in all four UK nations since 2010, and the health of the population is now lagging behind that of many of the EU15 and G7 countries.
Health Inequalities
The experts pointed out glaring health inequalities in the UK between the richest and poorest and between ethnic groups, particularly for preventable illness. Men in the least deprived areas of England can expect to live 18.6 years longer in good health than those in the most deprived areas, while for women the difference is 17.9 years.
The UK has done well at improving oral health and some chronic diseases like diabetes and kidney disease, compared with the EU15 and G7 countries.
Health Outcomes
The researchers said it has not kept pace for many other health outcomes, such as deaths from cardiovascular disease, cancer survival, and infant mortality ). The UK is also falling behind in terms of resources, with fewer nurses and doctors per person, and a lower number of hospital beds and medical equipment, than most EU15 and G7 countries .
Squeeze On Public Finances
The authors also noted explanations for the UK’s worsening relative performance and widening health inequalities include the squeeze on public finances since 2010 that affected many areas of public policy, particularly cuts in social care services, and the relatively high level of income inequality in the UK compared with other G7 and EU15 countries (f
Also important is that treatment continues to be prioritised over prevention, with funding for public health continuing to fall relative to NHS funding.
Against this background, the Commission draws on evidence from across the UK and internationally, as well as lessons from the pandemic, to set out seven policy recommendation ) to secure the NHS’ future as a better, fairer health service, and to strengthen its resilience to future health shocks and major threats to health (including an ageing population, the rise of multiple conditions, climate change, and antibiotic resistance).
This Commission was funded by the London School of Economics and Political Science Knowledge and Exchange Impact Fund (KEI) which was established using funding from the Higher Education Innovation Fund (HEIF)