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

The UK's response to the pandemicThe UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to COVID-19 or by excess mortality.The reasons for this high rate are complex and not yet fully understood, but elements of the UK Government response have been criticised, including delayed implementation of physical distancing measures, poor coordination with local authorities and public health teams, a dysfunctional track and trace system, and an absence of consultation with devolved nations.The role of the National Health Service (NHS) and relevant national executive agencies in relation to testing capacity, availability of personal protective equipment (PPE), the cancellation and postponement of many aspects of routine care, and decisions around discharge from hospital to care homes should also be critically examined.Conversely, aspects of the response by the NHS and relevant national executive agencies deserve recognition.In only a few weeks, capacity for critical care was mas sively expanded, many thousands of staff were reallocated, and services were reorganised to reduce transmission of SARS-CoV-2.The NHS also collaborated with academic institutions to share knowledge about clinical characteristics of the disease and to establish world-leading clinical trials on vaccines and treatments.The response to COVID-19 brings to attention some of the chronic weaknesses and strengths of the UK's health and care systems and real challenges in society to health.Failures in leadership, an absence of trans parency, poor integration between the NHS and social care, chronic underfunding of social care, a fragmented and disempowered public health service, ongoing staffing shortfalls, and challenges in getting data to flow in real time were all important barriers to coordinating a comprehensive and effective response to the pan demic.More positively, the high amount of financial protection that was provided by the NHS and an allocation of resources that explicitly accounted for differing geographical needs have, to some extent, mitigated the already substantial effect of the pandemic on health inequalities. The London School of Economics and Political Science-Lancet Commission on the future of the NHSThis UK-wide London School of Economics and Political Science (LSE)-Lancet Commission on the future of the NHS provides the first analysis of the initial phases of the COVID-19 response as part of a uniquely comprehensive assessment of the fundamental strengths of and chal lenges that are faced by the NHS.The NHS has long been regarded as one of the UK's greatest achievements, providing free care at the point of delivery for over 66 million people from birth to death.Against this backdrop, and considering international evidence, this Commission sets out a long-term vision for the NHS: working together for a publicly funded, integrated, and innovative service that improves health and reduces inequalities for all.This Commission makes seven recommendations, and associated subrecommendations, for both the short term and long term, with a 10-year timeline.First, increase investment in the NHS, social care, and public health.This Commission proposes that yearly increases in funding of at least 4%, in real terms, are needed for health, social care, and public health.Second, improve resource management across health and care at national, local, and treatment levels.Third, develop a sustainable, skilled, and fit for purpose health and care workforce to meet changing health and care needs.Fourth, strengthen prevention of disease and disability and preparedness to protect against major threats to health.Fifth, optimise diagnosis to improve outcomes and reduce inequalities.Sixth, develop the culture, capacity, and capability to become a so-called learning health and care system (ie, in which data-enabled infrastructures are routinely used to support policy and planning, public health, and personalisation of care).Finally, improve integration between health care, social care, and public health and across different providers, including the third sector (ie, charity and voluntary organisations).Central to the argument of this Commission is that an ongoing increase in funding for the NHS, social care, and public health is essential to ensure that the health and care system can meet demand, rebuild after the pandemic, and develop resilience against further acute shocks and major threats to health.This funding should be targeted towards increased investment in capital, workforce, preparedness, prevention, diagnosis, health information technology (HIT), and research and development.Furthermore, the NHS should develop new ways of working with patients and citizens.This Commission sets a vision of transformation to meet changing health