Five years on from his report for the Treasury, which paved the way for a 50% increase in NHS spending. Sir Derek Wanless has outlined deep concerns as well as successes in his latest review of the NHS.
The review for the King’s Fund, by the former NatWest bank chief, concludes that increases in funding have delivered notable improvements. It has resulted in more staff and equipment; improved infrastructure; reduced waiting times and better access to care; and improved care in coronary heart disease, cancer, stroke and mental health.
However, it also found that additional funding has not produced the improvements in productivity assumed in the original 2002 review – the costs of providing hospital and other services have increased. Hospital activity has increased, but the biggest increase has been in emergency rather than elective admissions, which raises doubts about how demand is being managed across the health service.
Derek Wanless warned that problems with the National Programme for IT (NPfIT) are also threatening to undermine future productivity gains. He raised concerns about the monopolistic contracts awarded by Connecting for Health, the agency responsible for the NPfIT, and recommended an independent audit of the programme to ensure the benefits outweigh the costs.
Progress on lifestyle behaviours has been slower than predicted. He praised progress on issues such as smoking, but said that dramatic rises in obesity are of great concern – with much higher levels than predicted in the 2002 review.
He said: “We are not on course to deliver the sustainable and world class health care system, and ultimately the healthier nation, that we all desire. Without significant improvements in NHS productivity, and much greater efforts to tackle obesity in particular, even higher levels of funding will be needed over the next two decades to deliver the comprehensive, high-quality services envisaged by my original review. Such an expensive service could undermine the current widespread political support for the NHS and raise questions about its long-term future.”
Criticism was also made about the radical structural changes to the NHS, which have been costly not just financially but in terms of “disruption, loss of experienced staff and changes in working relationships” both within the NHS and with other organisations.
Despite these concerns, Derek Wanless concluded that the broad direction of government health policy was “the right one”.
