The LSE-Lancet Commission has proposed seven changes to enhance the NHS’ response to the COVID-19 pandemic and improve healthcare throughout the entire U.K.

The report is the first comprehensive analysis of the initial phase of the country’s COVID-19 response and shows how healthcare in the U.K. lags behind that of other high-income countries. The pandemic, according to the commission, has exposed cracks in the NHS, including poor coordination between sectors, chronic underfunding, ongoing staffing shortages, and a fragmented public health service.

As a result, the delivery and quality of care in areas such as primary care and mental health services has suffered, with social and public health programs poorly resourced; improvements in life expectancy slowed in all four U.K. nations; health inequalities between the rich, poor and ethnic groups rising; and deaths from cardiovascular disease, cancer survival and infant mortality failing to improve.

"Our report refers to the need for improved integration between the NHS and local authorities," co-research lead of the commission, Dr. Michael Anderson from the London School of Economics and Political Science (LSE), told HCB News. He adds that the NHS and social care organizations "have a responsibility to play a full part in cross-sector partnerships with local authorities, community and voluntary sector organizations, relevant commercial organizations, schools, and other statutory service organizations."

In addition, spending has not kept pace with rising demand, needs and expectations, with the U.K. spending a lower proportion of GDP (10.3% in 2019) on health than other comparable high-income countries.

To address these concerns, the authors of the report suggest the following:

1. Annual increases in funding of 4% in real-terms for the NHS, social care, and public health over the next decade, as well as an immediate additional uplift in funding for social care and public health
2. Development of a "spending wisely" framework to optimize resource management across health and care services at national, local, and treatment levels
3. Creation of a sustainable, skilled and fit-for-purpose health and care workforce, coordinated on a U.K.-wide basis and tied into NHS and social care expenditure plans
4. Strengthen disease and disability prevention with cross-governmental action and earmarked funding, and preparedness to protect against major health threats
5. Develop and enhance diagnostics and novel diagnosis pathways to improve treatment outcomes and reduce inequalities
6. Enable routine use of data to become a health and care system that learns from every patient encounter, generate evidence to promote innovation and better care for individuals and populations
7. Improve integration across all sectors and providers of health and care services by strengthening primary care, removing the requirement to promote competition in England, and linking EHRs

The 4% increase in funding should take place in real terms every year over the next 10 years, according to the commission. Staffing salaries should also keep pace with average earnings, and investments should be made in capital to protect against major health threats. The commission also says an independent analysis of health and care workforce and resource needs should be implemented, along with a one-off injection of £3.2 billion each in social care spending and public health.

"Without these sustained increases in funding, the NHS will not be able to implement the improvements in workforce, population health, diagnosis, quality improvement or integration that we highlight," said Anderson. "Without this investment over the next decade, we will see 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."

Funding these recommendations is expected to cost £102 billion in total, according to the commission, and be achieved through progressive, broad-based general taxation. This would leave the U.K.’s tax burden slightly above the average of the G7 countries but still below the EU15 average.

The findings were compiled by 33 leading research, policy, management and clinical experts from all four constituent countries in the U.K.

The report was published in The Lancet.