Thirty years of efforts to transform the NHS from a national sickness service which treats disease to a national health service that focuses on prevention have failed, an official report said yesterday.

The burden of chronic disease is growing and threatens to overwhelm the NHS, the report stated, adding that smoking rates must be halved during the next 20 years, and the problems of obesity and health inequalities must be tackled now if the main threats to our future health are to be averted.

Previous efforts had achieved "little change on the ground" and a "step change" was needed, which, the report stated, required strong leadership to achieve a "fully engaged" population committed to health improvement.

Sir Derek Wanless, the former National Westminster Bank chairman commissioned by the Treasury to examine future demands on the NHS, tempered his criticism of past government inaction by saying responsibility for public health had to be shared with individuals. He said: "Individuals are primarily responsible for their own and their families' health, but the Government has a major role in the process by providing the necessary framework for success. Activity is needed on a wide front to help individuals to take responsibility."

The report, "Securing the Good Health of the Whole Population", comes almost two years after his first report, which backed a tax-funded NHS.

On the "fully engaged" scenario, the population would be healthier and the cost of the NHS £30bn a year less than on a "slow uptake" scenario. To achieve the former scenario, much more needed to be done by introducing new taxes and incentives, making new regulations and sharing good practice, Sir Derek said.

Targets for reducing smoking, obesity and other risk factors should be set for three and seven years, he said, stating that the government target of reducing obesity levels to 8 per cent by 2010 from their current levels of more than 20 per cent was unrealistic. "It is another good example of targets not being followed through," Sir Derek said.

Banning smoking in workplaces would be more cost effective than putting extra investment into smoking cessation services, the report said. But subsidising gym membership would be a poor use of public money because it might not increase exercise - if people did not use the gym - and would disproportionately benefit the better off. There was an arguable case for extending specific taxes to foodstuffs which contain harmful ingredients, while subsidising healthier products, though the report acknowledged that a so-called "fat tax" would raise complex issues. Sir Derek said he had deliberately avoided prescribing specific interventions because they needed to be co-ordinated across government departments.

New laws could help, provided they were backed by the public, Sir Derek said. For example, he said seat belts became compulsory only after years of gradual acceptance. He said: "Regulations used to lead, or reflect, social trends tend to be much more successful than those that go against the grain."

The Department of Health is to publish a White Paper on public health in the summer. John Reid, the Health Secretary, welcomed Sir Derek's report as "an important contribution". Tim Yeo, the Tory health spokesman, said: "I am delighted the Wanless report has challenged the Government to tackle the country's public health problems."



The Government's target is to reduce smoking from 28 per cent of adults to 24 per cent by 2010. That is described as "unambitious" by Sir Derek Wanless. To achieve the "fully engaged" scenario, smoking needs to fall to below 20 per cent by 2010 and to 13 per cent by 2022 - less than half its current level, the report says.


More than half the population of England is currently overweight or obese. In children, the number who are overweight or obese increased by 25 per cent between 1995 and 2002. Obesity reduces life expectancy by nine years on average. There are no national targets on obesity. The previous government set targets to reduce obesity to 6 per cent of men and 8 per cent of women by 2010, which were now unrealistic, Sir Derek said. "Another good example of targets not being followed through," the report says.


Currently, just 40 per cent of men and 26 per cent of women take enough exercise - defined as 30 minutes of moderately intense physical activity on five or more days a week. In Australia and Finland, levels of physical activity are higher. On this basis, a Cabinet Office report recommended in 2002 that the Government should set a target of 50 per cent of adults achieving the recommended activity level by 2010 and 70 per cent by 2020.