Leading article: Some uncomfortable truths

It is appropriate that Sir Derek Wanless should be the author of a report for the King's Fund that evaluates the effect on the National Health Service of the massive amounts of public money that have been spent in recent years. It was Sir Derek's report for the then Chancellor, Gordon Brown, in 2002 that provided the economic justification for an unprecedented injection of cash into our health infrastructure.

The conclusions on how this money has been spent do not make for happy reading. True, there are some encouraging findings. Sir Derek has found that the increases in funding have delivered shorter waiting times and better heart, cancer and mental heath care.

But Sir Derek also argues that the vast sums spent on extra pay for staff have failed to produce sufficient benefits for patients. In other words, we have received poor value for money as a result of the way the Government has spent our tax. This confirms what this newspaper has long argued about the Government's policy towards the NHS: too much money has been poured into an unreformed and inefficient system. Before turning on the funding taps full blast, ministers should have demanded deep reform of working practices and the decentralisation of structures. The lack of scrutiny and foresight shown by ministers when negotiating the new GP contract was particularly scandalous.

The report also delivers some uncomfortable truths with regard to the long-term viability of the NHS. Sir Derek concludes that if obesity (a condition that often results in heart disease, diabetes and high blood pressure) is not curbed, the system will come under unbearable financial strain. To maintain its present range of services in a time of growing demand the NHS will need funding increases of at least 4 per cent a year. The problem is that the funding injection which began in 2002 is beginning to slow to below this level.

In truth, the resources question is linked to the question of reform. The NHS has functioned for most of its half-century of life more like a national sickness service, rather than a health service. It has regarded its primary duty as curing and caring for those people who fall ill. But the key is to stop as many of them as possible becoming sick in the first place.

This means channelling resources into public information campaigns on healthy eating and the need for regular exercise. There is much more that GPs should be doing to stop patients – especially the young – damaging their health through poor lifestyle choices.

This report should not be read as a counsel of despair. Rather, it provides yet more evidence that the only future for the NHS is one of reform.