Securing Our Future Health: Taking a Long-Term View : A report by Derek Wanless
The final report by Derek Wanless has been released. It is available on line at
This report, arguably the most significant review of the NHS since its inception, advocates a substantial rise in health care expenditure by 2022, but importantly many organisational changes including a more wide spread use of cost effectiveness analysis, increase in IT, a change in workforce balance, shift from hospital to primary care, and increase in social care are also required. He does not recommend increasing out of pocket charges for services, although charges for non clinical services might be increased. The case for exemptions from prescription charges seems illogical and he suggest it shoud be reexamined. Increased public and patient engagement with NHS management is also recommended.
I have not had much time to go through this properly but some key points are summarised below
LSE Health and Social Care
Principle conclusions are that by 2022 NHS needs to rise to between £154 billion and £184 billion (2002-2003 prices) from its current level of £68 billion. Implying a real increase year on year of between 4.1 and 5.2 per cent. Howevere the fastets period of grwoth is in the early years, and it is recommended that over the next five years public health care expenditure increase in real terms by 7.1 to 7.3 per cent. Total health care spending as a percentage of GDP in the UK would rise from approximately 7.7 per cent today to somewhere between 10.6 and 12.5 per cent of GDP by 2023. Substantial expansion and change of skill mix in the work force is also required.
The report also considers social care, even though this was not in the original remit. More resources are required for social care. At current spending levels given demographic trends expenditure will increase from £6.4 billion in 2002-2003 to between £10 and £11 billion by 2023. Wanless considers these to be substantial underestimates of the resources that will be required.
Wanless recommends that NICE consider older technologies as well as new ones to determine if they are cost effective. There should be better intergration of clinical guidelines with National Service Frameworks
He suggest a key priority area is development of Information Communications Technology within the NHS (ring fenced funds)
Greater use of evidence based principles in public health care programmes
Greater shift away from hospital to primary care
Out of pocket payments should not be extended but there is scope for extending charges for non clinical services. The policy on exemptions from NHS prescription charges might also be reconsidered.
Financial incentives should be explored to reduce bed blocking
Improving publi and patient engagement with the health service
All the best