The London School of Economics (LSE) and Political Science–Lancet Commission on the future of the NHS said UK healthcare spending as a share of gross domestic product (GDP) is lower than average spend across G7 countries (Canada, France, Germany, Italy, Japan, the UK and the US).
It argued that the Covid pandemic has brought out the best and worst in the NHS, by offering protection to people in differing regions but showing up poor integration between the NHS and social care, chronic underfunding of social care and too few staff.
In its new report, the Commission offers a long-term solution to NHS troubles with seven main recommendations, including “yearly increases in funding of at least 4% in real terms” for health, social care and public health over the next decade.
Alongside this long-term funding commitment, the Commission recommends a one-off injection in social care spending (£3.2 billion in England in 2018/19 terms) and public health (also £3.2 billion in England in 2018/19 terms).
It said this would raise the point at which people have to pay for their own care from £23,250 to £100,000, and introduce a cap on care costs of £75,000.
In the study, the Commission further argues that a “sustainable, skilled, and fit for purpose health and care workforce” is also needed to meet changing health and care needs.
Other recommendations include being prepared for future health threats, greater effort to reduce inequality and improve outcomes for illnesses such as cancer and heart disease, and better integration of health and social care.
The experts also reject any calls for reorganisation of the NHS on a large scale.
“Past experiences have taught us that reorganisation on a large scale is often a disruptive process without any evidence of benefit,” the report said.
On staffing, the UK is falling behind in terms of resources, according to the study, with fewer nurses and doctors per person, and a lower number of hospital beds and medical equipment, than most EU and G7 countries.
The report points to around 200,000 staff vacancies in England alone, with one in 12 posts in the NHS and one in 14 posts in social care laying vacant.
Co-research lead, Dr Michael Anderson, from LSE, 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.”
Commission co-chair, Professor Elias Mossialos, also from LSE, added: “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.
“But 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.
“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.”
Co-research lead, Dr Emma Pitchforth, from the University of Exeter, said: “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.
“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.”