Reforming the NHS: key proposals by LSE-Lancet commission


The Covid-19 pandemic has revealed the best and worst in the NHS: protection has been offered to people in differing regions but poor integration between the service and social care has been evident, and so too the chronic underfunding of social care and low staff numbers, according to a report from the London School of Economics-Lancet commission.

The commission, looking at the possible future of the NHS, has called on the government to commit to long-term funding for healthcare, and set out other recommendations to try to solve the troubles facing the NHS.

Here are some of the key issues:

Funding of the NHS, social care and public health

Plan: The LSE-Lancet commission proposes a £102bn increase in UK spending on the NHS, social care and public health, taking the total outlay from £185bn now to £288bn by 2030-31. That would involve increasing the budget of each of those three services by 4% a year every year for 10 years.

Most of the £102bn would come from rises in income tax, national insurance and VAT. Initially there would be a 1p increase in all three by 2025-26 – a move the experts call “progressive, broad-based, general taxation” – and further 2p uplifts in both income tax and NI by 2030/31.

Analysis: Any government would think very hard about committing to such large increases over so many years, especially given that more than £300bn has already been spent tackling Covid. The commission admits that securing ministerial approval for such tax rises would be “challenging in economically and geopolitically uncertain times”.

Social care

Plan: The sector needs an immediate £3.2bn cash injection to improve and expand care forelderly people, children and disabled people, the experts say. They also propose making the means test for receipt of free social care much more generous by raising the savings people can hold from £23,250 to £100,000 before they no longer qualify for local authority care funding, and capping care costs at £75,000.

Analysis: The multiple financial and political risks involved in replacing the creaking, inadequate, social care system in England with a high-quality and affordable alternative help explain why successive governments have examined the problem but, despite pressure to act, taken no meaningful action.

Boris Johnson pledged to fix the problem as soon as he entered Downing Street in 2019 but has done nothing and has dropped plans for social care reform from the Queen’s speech next week. It is unclear when any government will grasp the nettle and push through radical change.

Public health

Plan: This sector also needs its own £3.2bn budget boost straight away, the commission says. That would help make up for years of cuts to public health budgets, ensure more money goes to poorer areas, where the burden of preventable illness is higher, and expand the workforce. The 4% rises would allow public health teams to do more to reduce the number of people suffering from cancer and heart disease and close the gap on this between Britain and other rich nations.l

Analysis: The experts make the case for big budget rises for all three services, not just the NHS, given that weaknesses in social care and public health drive demand for NHS care. But the sums of money thought necessary are unlikely to gain Treasury approval. And tough government action to curb smoking, drinking and especially poor diets, would arguably do as much to improve the nation’s health, and stop people getting ill in the first place, than the work of public health teams.

Sustainable and fit-for-purpose health and care workforce

Plan: Each of the four nations in the UK should draw up a strategy to guarantee that they will have enough skilled staff in the NHS and social care in future, with workforce planning then coordinated across the UK from 2022. Technology, such as remote appointments, should be deployed to help as far as possible.

Analysis: Widespread staff shortages led to the NHS in England drawing up its NHS people plan, but it was short of practical solutions that would make a big difference and not backed by any new funding. The LSE-Lancet report does not set out any compelling new ideas for ensuring sufficient supply of care staff in the years ahead either, even though Britain is involved in a global race to recruit doctors and nurses.



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