Lessons from the NHS for UHC and health security :

In 2018, to mark the 70th anniversary of the UK National Health Service (NHS), a new Commission was established by The Lancet and London School of Economics to independently evaluate the NHS and its role in health in the UK. After 3 years, much has changed. The Commission began with concerns about stalling life expectancy, rising inequality, and comparatively poor health outcomes, such as those for cancer and maternity care. Today, the Commission reports during a historic pandemic, in which the UK excess death rate has been very high. The pride and support that much of the public feel for the NHS remain high. With such a strong health-care system, how could the UK perform so badly relative to other countries during the COVID-19 pandemic? And what does this mean for the future of universal health coverage, and for the NHS? The Commission reports that the NHS has succeeded in providing universal services free at the point of delivery; it emphasises the position of the NHS at the heart of UK society, staffed by dedicated health workers. However, the Commission also highlights large staffing shortfalls and relative low funding (the UK spends over 1% less of its GDP on health compared with the G7 average).
The Commission shows how previous deprioritisation of public health and social care led to poor national population health before the COVID-19 pandemic. Describing a high level of income inequality in the UK, and a gradient of life expectancy with economic deprivation both regionally and nationally, the Commission calls out glaring health inequalities, discrimination, and structural racism, evidenced by the worse health outcomes in many minority ethnic groups, including Black, Pakistani, and Bangladeshi people. The authors also emphasise that the NHS has not been able to respond adequately to the changing needs of the population. Despite a growing burden of non-communicable diseases and mental health problems, the NHS focuses on treatment, rather than shifting to prevention. The limitations of universal health coverage when imagined simply as the provision of services in response to illness echo ideas from a Lancet Health Policy paper, which discusses how misalignment between the concepts of universal health coverage and global health security has hampered responses to the COVID-19 pandemic.
According to Arush Lal and colleagues, in countries that have traditionally focused on universal health coverage and provision of services, not enough attention has been given to public health and outbreak control, and in countries that focused on global health security, provision of universal health coverage has been relatively neglected. Before the pandemic, the UK was considered to have both strong universal health coverage and global health security systems. Discussing the UK, Lal and colleagues suggest that confidence in the health-care system contributed to complacency, delaying capacity building and leading to fragmented global health security responses. The UK’s inability to protect its citizens from the COVID-19 pandemic must force re-examination of our understanding of successful universal health coverage and global health security.
A true long-term response to the human devastation of the pandemic will only occur if we understand the crisis of the past year as a syndemic—a synthesis of epidemics—which has both biological and social interactions. The focus on universal health coverage must shift from providing the minimum finance required to deliver services, to the equitable provision of health, including public health security, healthy communities, and fully integrated health research.
During the COVID-19 pandemic, the UK’s research system has made critical contributions to saving lives, but must be further strengthened and better coordinated with clinical care. A health system envisaged through the traditional view of covering overheads for delivering certain services— eg, the NHS seen through the dimensions of workforce, products, money, and services—is not enough to deliver health to a population or to protect a population from health threats. There is a real danger that the success of the UK vaccination programme is obscuring the scale of the reforms necessary to protect and strengthen the health of the UK population. Broader concepts of health and wellbeing must be placed at the centre of government policy. Investment in public services that reduce inequality is necessary to maintain and improve population health and protect the UK population from future health threats. Lessons from the UK and the NHS show that universal health coverage is broader than health-care provision alone, and that a healthy population must be considered a prerequisite for health security and preparedness.
Source : Lancet