Wanless: report published

The Wanless report has called for a greater percentage of national income to be spent on healthcare over the next two decades.

The report, "Securing our future health: Taking a long term view", calls for a seven per cent boost in health spending each year over the next five years, with slower rates of growth in subsequent years.

But Derek Wanless, the former chief executive of the NatWest Bank, warned that in return for extra funding, the NHS needs to modernise further.

"Resources and reform must go hand in hand, both are vital. Neither will deliver without the other," he said.

Downing Street said the report was the first time an evidence-based assessment of the requirements of the NHS had been made and described it as "a heavyweight piece of work".

But the Conservatives said the review had been set up in such a way that it could "draw only one possible conclusion".

Overshadowed

Opposition politicians have attacked the shortage of time given to examine the report's findings.

But Wanless said the report had only been presented to the prime minister, chancellor and health secretary on Monday.

And he denied that releasing the report on Budget day would result in it being overshadowed. The debate "won't be over in one day" he said. "I've done exactly what I intended to do."

Modernisation

Wanless sets out a vision of a modernised NHS, going further than current NHS plans. He suggests a maximum waiting time of two weeks by the end of the review period in 2022.

The report calls for higher capacity in the health service - employing 25,000 more doctors than currently envisaged by ministers - but warns that attempts to ramp up growth too quickly in the short term could hit capacity constraints.

There is also a significant emphasis on improvements in productivity, particularly those driven by better use of information and communications technology (ICT).

"Current use of [ICT] is extremely poor," says the report.

Despite calling for a "step change" in spending on technology, Wanless concedes that plenty of big government technology projects have failed in recent years.

The report sets out three future scenarios for "catching up" with best healthcare practice and then matching the performance of other countries.

Solid progress

The "solid progress" scenario, described by Wanless as representing "a good performance", envisages the public doing more to look after their own health, with life expectancy rising and the health service making extensive use of technology to spend resources efficiently.

The percentage of GDP spent on health, including private healthcare, would rise from an estimated 7.7 per cent in the current financial year to 9.4 per cent in 2007/08 and eventually reach 11.1 per cent in 2022/23.

This would represent a rise in total NHS spending of £93 billion over the next 20 years.

The scenario would see rapid initial rises in annual NHS budgets of 6.8 per cent in 2002/03 and 7.1 per cent in 2007/08.

Fully engaged

In the most radical "fully engaged" scenario, the public do more to look after their own health, health status improves dramatically, and the health service makes the best use of resources and new technology.

As with the solid progress scenario, there is a rapid expansion of funding, but as resources are used more efficiently, the need for higher spending reduces and by 2012/13 marginally less cash is needed to meet healthcare commitments.

By 2022/23 total NHS spending is projected at £154 billion, around £7 billion lower than in the solid progress scenario.

Slow uptake

The "slow uptake" scenario - the most pessimistic of the three - envisages no change in public engagement with their healthcare, constant or deteriorating levels of health across the population and NHS productivity remaining low.

With public health failing to improve, total healthcare spending would need to reach 12.5 per cent of GDP by 2022/23, and NHS spending could hit £184 billion by the same financial year - substantially more than in the other scenarios.

By 2007/08 the need for more cash to compensate for poor performance would become apparent, with average annual real growth needed to hit 7.3 per cent, compared with 7.1 per cent in both other scenarios.

Reward for failure?

Wanless says that a failure to respond to the challenge of increased productivity and increased awareness about personal health could mean that the taxpayer has to pay an additional £30 billion a year to get the NHS into shape by 2022.

This would raise questions about whether the current model of organisation is effective or whether increasing amounts of cash would be vanishing into a "black hole".

Wanless said that ministers might decide that the slow uptake model would be "unfinancable".

But he defended the conclusion that large spending increases are needed in the current parliament.

"I believe that it is right that there should be substantial investment quickly," he said.

"There is an unacceptable gap in performance between the reality of the NHS today and what will be expected and needed in the future.

"But this investment must not be more than can be sensibly spent. My projections reflect this balance, but represent a very considerable management challenge."

Social care

Wanless said the initial remit set by the Treasury had neglected the importance of linking health care with social care.

"No review of healthcare resources would be complete without considering the link between them," he wrote.

He said an immediate review would need to be carried out. "It would be a good idea for someone to start it now," Wanless suggested.

The report indicated that spending on personal social services for the elderly and adults with physical and learning disabilities would rise from £6.4 billion in 2002/03 to between £10 billion and £11 billion in 2022/23.

Lib Dem health spokesman Evan Harris said the report showed Labour's failure on social services.

"The Wanless Report admits what the government has always denied - that the number of social care places has fallen disastrously. The crisis in the care system not only victimises the most vulnerable, but creates a huge and tragic waste of much needed acute hospital beds," he said.

Review limitations

Opposition politicians have accused the government of attempting to shut down debate over the health's service's future.

They said ministers were seeking to shift the debate onto how much should be spent on the NHS - rather than allowing an open-ended study into the merits of alternative funding methods.

Wanless said the review had taken the starting point as a given. "All countries have a mix of funding," said Wanless. "Other systems have advantages...but don't expect them to add up to a cheaper health service overall."

Shadow health secretary Dr Liam Fox said the report showed Labour had "a closed mind about the future of healthcare".

"Gordon Brown's terms of reference meant that Derek Wanless could draw only one possible conclusion. If asked a Labour question you get a Labour answer," he said.

"It is not surprising that Gordon Brown has tried to bury this report by releasing it on the day of the Budget. The report itself concludes that it needs to be repeated in five years' time because of a lack of quality information. The projections it makes are therefore ridiculous."

Structural change

Wanless said that with the NHS now engaged in a wide-ranging modernisation process, it was important to avoid any further "disruptive change".

Arguments against more radical reform plans were "persuasive", he said.

But within the existing plans, he said there was a need for more decentralisation and freedom to innovate.

"There is no reason why the pace of decentralisation should be uniform," he said.

And he warned ministers against setting too many targets, saying this could create the danger of "resource misallocation" as cash is spent meeting targets to the exclusion of other important issues.

It is much better to audit NHS performance "in the round", he said.

"The danger is you set to many targets in complex systems and resources get misallocated," he added.