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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 reco...

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Background Spending on the UK National Health Service (NHS) has risen by an average of 4% a year in real terms since its introduction in 1948. This growth has now halted due to reductions in public spending. The English NHS is therefore targeting efficiency savings of £15–20 billion by 2014–15 to meet rising pressures. This research looks beyond 2014–15 to estimate the financial challenge facing the NHS in England in 2021–22, examining the potential impact of various policies in managing these pressures. Methods To estimate funding pressures facing the English NHS, healthcare activity was broken down by type: acute, maternity, mental illness, general practice, and prescribing. A least-squares approach was used to model determinants of demand for each type in the base year. Results were applied to projections of population, mortality and chronic conditions, with estimated cost then applied. The cost of projected healthcare activity was compared to potential scenarios for government funding of the English NHS, with the gap representing the required efficiency gain by 2021–22. The effect of three key factors on closing this gap was examined: pay restraint, management of chronic conditions demand, and increased acute sector productivity. Results Funding pressures on acute NHS services in England are estimated to rise by 3% a year due to combined effects of population change and rising hospital admissions for chronic conditions. If pay rises with recent trend, total acute sector pressure will rise by 4% a year. If spending remains flat in real terms, the funding gap will reach £44–54 billion in 2021–22. If the current efficiency challenge is met in 2014–15, this reduces to £28–34 billion. Closing this gap will require a combination of measures: releasing all savings related to productivity gains made prior to 2015–16 (£6bn), preventing increases in the probability of being admitted to hospital with a chronic condition (£6bn), and restricting pay growth to rising with inflation (£8bn). The remaining £8bn gap will require further productivity gains of 1% a year between 2015–16 and 2021–22. Conclusion The current austerity experienced by the English NHS is likely to extend beyond the 4-year period to 2014–15 that is currently the focus of planned efficiency savings. If funding pressures increase with recent trends, further savings of 4% a year will be needed between 2015–16 and 2021–22 to meet rising demands on healthcare. This will require unprecedented sustained increases in health service productivity to avoid cuts to services or falls in quality.

At present, health systems across Europe face the same challenges: a changing demographic profile, a rise in multi-morbidity and long-term conditions, increasing health care costs, large public debts and other legacies of an economic downturn. In light of these concerns, this article provides an overview of the international evidence on how to improve productive efficiency in secondary care settings. Updating and expanding upon a recent review of the literature by Hurst and Williams (2012), we set out evidence on potential interventions in the policy environment, hospital management, and operational processes. We conclude with five key lessons for policy makers and practitioners on how to improve productive efficiency within hospital settings, and identify several gaps in the existing evidence base.

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ObjectivesTo assess the association between market concentration of hospitals (as a proxy for competition) and patient-reported health gains after elective primary hip replacement surgery.MethodsPatient Reported Outcome Measures data linked to NHS Hospital Episode Statistics in England in 2011/12 were used to analyse the association between market concentration of hospitals measured by the Herfindahl-Hirschman Index (HHI) and health gains for 337 hospitals.ResultsThe association between market concentration and patient gain in health status measured by the change in Oxford Hip Score (OHS) after primary hip replacement surgery was not statistically significant at the 5% level both for the average patient and for those with more than average severity of hip disease (OHS worse than average). For 12,583 (49.1%) patients with an OHS before hip replacement surgery better than the mean, a one standard deviation increase in the HHI, equivalent to a reduction of about one hospital in the local market, was associated with a 0.104 decrease in patients’ self-reported improvement in OHS after surgery, but this was not statistically significant at the 5% level.ConclusionsHospital market concentration (as a proxy for competition) appears to have no significant influence (at the 5% level) on the outcome of elective primary hip replacement. The generalizability of this finding needs to be investigated.

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