The Lancet

Enrico M Bucci,Johannes Berkhof,André Gillibert,Gowri Gopalakrishna,Raffaele A Calogero,Lex M Bouter,Konstantin Andreev,Florian Naudet,Vasiliy Vlassov

doi : 10.1016/S0140-6736(21)00899-0

CORRESPONDENCE| VOLUME 397, ISSUE 10288, P1881-1883, MAY 22, 2021

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Data discrepancies and substandard reporting of interim data of Sputnik V phase 3 trial – Authors' reply

Denis Y Logunov,Inna V Dolzhikova,Dmitry V Shcheblyakov

doi : 10.1016/S0140-6736(21)00894-1

CORRESPONDENCE| VOLUME 397, ISSUE 10288, P1883-1884, MAY 22, 2021

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Refugee access to COVID-19 vaccines in Lebanon

Nadine K Jawad,Lina Abu Taweeleh,Jad A Elharake,Nicole Khamis,Osaid Alser,Fatima M Karaki,Layla Aboukhater

doi : 10.1016/S0140-6736(21)00925-9

CORRESPONDENCE| VOLUME 397, ISSUE 10288, P1884, MAY 22, 2021

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Department of Error

doi : 10.1016/S0140-6736(21)01117-X

DEPARTMENT OF ERROR| VOLUME 397, ISSUE 10288, P1884, MAY 22, 2021

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Department of Error

doi : 10.1016/S0140-6736(21)01116-8

DEPARTMENT OF ERROR| VOLUME 397, ISSUE 10288, P1884, MAY 22, 2021

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Department of Error

doi : 10.1016/S0140-6736(21)01069-2

DEPARTMENT OF ERROR| VOLUME 397, ISSUE 10288, P1884, MAY 22, 2021

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Department of Error

doi : 10.1016/S0140-6736(21)01118-1

DEPARTMENT OF ERROR| VOLUME 397, ISSUE 10288, P1884, MAY 22, 2021

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Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study

The African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators

doi : 10.1016/S0140-6736(21)00441-4

ARTICLES| VOLUME 397, ISSUE 10288, P1885-1894, MAY 22, 2021

There have been insufficient data for African patients with COVID-19 who are critically ill. The African COVID-19 Critical Care Outcomes Study (ACCCOS) aimed to determine which resources, comorbidities, and critical care interventions are associated with mortality in this patient population.

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18F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide postprostatectomy salvage radiotherapy for prostate cancer (EMPIRE-1): a single centre, open-label, phase 2/3 randomised controlled trial

Ashesh B Jani,Eduard Schreibmann,Subir Goyal,Raghuveer Halkar,Bruce Hershatter,Peter J Rossi,Joseph W Shelton,Pretesh R Patel,Karen M Xu,Mark Goodman,Viraj A Master,Shreyas S Joshi,Omer Kucuk,Bradley C Carthon,Mehmet A Bilen,Olayinka A Abiodun-Ojo,Akinyemi A Akintayo,Vishal R Dhere,David M Schuster

doi : 10.1016/S0140-6736(21)00581-X

ARTICLES| VOLUME 397, ISSUE 10288, P1895-1904, MAY 22, 2021

Molecular imaging is increasingly used to guide treatment decisions and planning in prostate cancer. We aimed to evaluate the role of 18F-fluciclovine-PET/CT in improving cancer control compared with conventional imaging (bone scan and either CT or MRI) alone for salvage postprostatectomy radiotherapy.

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Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals

Matthew D McHugh,Linda H Aiken,Douglas M Sloane,Carol Windsor,Clint Douglas,Patsy Yates

doi : 10.1016/S0140-6736(21)00768-6

ARTICLES| VOLUME 397, ISSUE 10288, P1905-1913, MAY 22, 2021

Substantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. We aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated.

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Hyperparathyroidism shows its hand: findings of osteitis fibrosa cystica

Luis Rivas-Prado,Alejandro Morales-Ortega,Sonia Allodi-de la Hoz,David Bernal-Bello

doi : 10.1016/S0140-6736(21)00796-0

CLINICAL PICTURE| VOLUME 397, ISSUE 10288, P1914, MAY 22, 2021

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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

Michael Anderson,Emma Pitchforth,Miqdad Asaria,Carol Brayne,Barbara Casadei,Anita Charlesworth,Angela Coulter,Bryony Dean Franklin,Cam Donaldson,Michael Drummond,Karen Dunnell,Margaret Foster,Ruth Hussey,Paul Johnson,Charlotte Johnston-Webber,Martin Knapp,Gavin Lavery,Marcus Longley,Jill Macleod Clark,Azeem Majeed,Martin McKee,John N Newton,Ciaran O'Neill,Rosalind Raine,Mike Richards,Aziz Sheikh,Peter Smith,Andrew Street,David Taylor,Richard G Watt,Moira Whyte,Michael Woods,Alistair McGuire,Elias Mossialos

doi : 10.1016/S0140-6736(21)00232-4

THE LANCET COMMISSIONS| VOLUME 397, ISSUE 10288, P1915-1978, MAY 22, 2021

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The changing health needs of the UK population

Martin McKee,Karen Dunnell,Michael Anderson,Carol Brayne,Anita Charlesworth,Charlotte Johnston-Webber,Martin Knapp,Alistair McGuire,John N Newton,David Taylor,Richard G Watt

doi : 10.1016/S0140-6736(21)00229-4

HEALTH POLICY| VOLUME 397, ISSUE 10288, P1979-1991, MAY 22, 2021

The demographics of the UK population are changing and so is the need for health care. In this Health Policy, we explore the current health of the population, the changing health needs, and future threats to health. Relative to other high-income countries, the UK is lagging on many health outcomes, such as life expectancy and infant mortality, and there is a growing burden of mental illness. Successes exist, such as the striking improvements in oral health, but inequalities in health persist as well. The growth of the ageing population relative to the working-age population, the rise of multimorbidity, and persistent health inequalities, particularly for preventable illness, are all issues that the National Health Service (NHS) will face in the years to come. Meeting the challenges of the future will require an increased focus on health promotion and disease prevention, involving a more concerted effort to understand and tackle the multiple social, environmental, and economic factors that lie at the heart of health inequalities. The immediate priority of the NHS will be to mitigate the wider and long-term health consequences of the COVID-19 pandemic, but it must also strengthen its resilience to reduce the impact of other threats to health, such as the UK leaving the EU, climate change, and antimicrobial resistance.

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Securing a sustainable and fit-for-purpose UK health and care workforce

Michael Anderson,Ciaran O'Neill,Jill Macleod Clark,Andrew Street,Michael Woods,Charlotte Johnston-Webber,Anita Charlesworth,Moira Whyte,Margaret Foster,Azeem Majeed,Emma Pitchforth,Elias Mossialos,Miqdad Asaria,Alistair McGuire

doi : 10.1016/S0140-6736(21)00231-2

HEALTH POLICY| VOLUME 397, ISSUE 10288, P1992-2011, MAY 22, 2021

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, small-scale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2·4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.

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What is the right level of spending needed for health and care in the UK?

Anita Charlesworth,Michael Anderson,Cam Donaldson,Paul Johnson,Martin Knapp,Alistair McGuire,Martin McKee,Elias Mossialos,Peter Smith,Andrew Street,Michael Woods

doi : 10.1016/S0140-6736(21)00230-0

HEALTH POLICY| VOLUME 397, ISSUE 10288, P2012-2022, MAY 22, 2021

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this Health Policy paper, we look at the economic impact of the COVID-19 pandemic and historical spending in the UK and comparable countries, assess the role of private spending, and review spending projections to estimate future needs. Public spending on health has increased by 3·7% a year on average since the National Health Service (NHS) was founded in 1948 and, since then, has continued to assume a larger share of both the economy and government expenditure. In the decade before the ongoing pandemic started, the rate of growth of government spending for the health and care sector slowed. We argue that without average growth in public spending on health of at least 4% per year in real terms, there is a real risk of degradation of the NHS, reductions in coverage of benefits, increased inequalities, and increased reliance on private financing. A similar, if not higher, level of growth in public spending on social care is needed to provide high standards of care and decent terms and conditions for social care staff, alongside an immediate uplift in public spending to implement long-overdue reforms recommended by the Dilnot Commission to improve financial protection. COVID-19 has highlighted major issues in the capacity and resilience of the health and care system. We recommend an independent review to examine the precise amount of additional funds that are required to better equip the UK to withstand further acute shocks and major threats to health.

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