The NHS needs an annual funding boost of at least 4% over the next decade and a one-off a £102bn injection to help improve its provision of care, the Lancet Commission has said.
In a report (6 May), it said that the Government should commit to increasing NHS funding by a ‘minimum of 4% a year in real terms’ over the next 10 years to address ‘substantial workforce shortfalls’, to improve system resilience to health threats, and to ensure several years of austerity are ‘rectified’.
Any amount less than its recommendation would pose a ‘real risk of degradation of the NHS’, it said.
Alongside this long-term commitment, the Commission also proposed a £102bn increase in UK spending on the NHS, social care and public health.
It suggested this could be achieved through a 1p increase to VAT, personal income tax and national insurance (NI) by 2025-26, and then further increasing personal income tax and NI to 2p by 2030-31.
NHS reorganisation ‘disruptive’
Although there is a need for improved integration of health and social care, the report warned against further major reorganisations of the NHS, instead recommending that workforce planning to address primary care’s limited capacity would be crucial.
The Commission said that there is ‘little evidence’ that attempts at large scale reorganisation have improved integration across health and care.
‘By contrast, it has been argued by policy commentators that the Health and Social Care Act 2012 has led to greater fragmentation of services and challenges when commissioning services,’ it said.
Instead of further ‘unnecessary reorganisations’, it argued that focus should be placed on further integration of existing services – with legislation to support the removal of system barriers – to improve health and care.
‘Primary care has a natural role as a key facilitator for many aspects of integrated care. However, its capacity to do so has been reduced with funding and workforce pressures,’ it said.
‘Reinforcing and reorienting the capacity of primary care will help to reduce system complexity. This Commission therefore emphasises adequate funding and workforce planning for primary care as crucial to the success of integrated health and care systems in all constituent countries.’
It also cited similar criticism that the Government’s replacement of Public Health England (PHE) with the UK Health Security Agency during the pandemic ‘has risked substantial disruption’.
Professor Alistair McGuire, co-chair of the Commission and from the London School of Economics, said that the NHS ‘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.’
The Commission also recommended:
- The development of a framework to better manage resources across health services at national and regional levels
- Strengthening prevention of disease and disability with cross-government action and earmarked funding
- Improved diagnostics and novel routes to diagnosis to reduce inequalities and improve treatment outcomes
- Enabling the routine use of data to create a health system that learns from patient encounters to provide better care and promote innovation.