It was published yesterday, five years after his review for the Treasury paved the way for the extra £43.2 billion that the Government has since spent on the NHS.

Sir Derek, a former chief executive of NatWest bank, sees some improvements in the service, but also identifies a range of failings, including mismanaged structural changes; generous pay deals that failed to produce an obvious return; and a neglect of public health.

He said at the publication of his report that the extra resources had undoubtedly improved patient care over the past five years. “But what is equally clear from this review is that we are not on course to deliver the sustainable and world-class healthcare system, and ultimately the healthier nation, that we all desire,” he said.

Sir Derek would have liked the Government to have commissioned the review, but it showed no enthusiasm for doing so. The King’s Fund stepped in, enabling him to produce this report.

He states that more money will be needed over the next two decades unless steps are taken to deal with pressing concerns. That could undermine the current widespread political support for the NHS “and raise questions about its long-term future”, he says.

Of the more than £43 billion extra that has been spent, pay and price inflation have accounted for £18.9 billion, he concludes. New contracts for consultants, GPs and other staff have been introduced, but “there is very little robust evidence so far to demonstrate significant benefits arising from the new pay deals”.

Staff numbers have risen far above the targets set in the NHS Plan of 2000, with targets for consultants exceeded by 16 per cent, for GPs by 166 per cent, for nurses by 272 per cent, and for therapists by 102 per cent.

The biggest increase in NHS activity has been in accident and emergency departments, where attendances have grown by more than a third since 2002-03. This is hard to explain, but is probably caused by changes in behaviour, shorter waiting times and changes in GPs’ out-of-hours arrangements, the report says.

Public health budgets, aimed at tackling issues such as obesity and smoking, had been raided to bridge financial problems in the NHS, he said. It was impossible to track trends in public health spending or health promotion in the past five years because no official figures were kept.

Sir Derek said: “It is also indicative of the relatively low priority given to public health that, while non public health medical staff numbers have increased by nearly 60 per cent since 1997, the number of public health consultants and registrars has gone down overall.”

Sir Derek said at the publication of the report that there were “lots of positives” in his study. These included reduced waiting times, the use of less expensive statins and extra staff. He said that the framework introduced by the Government should remain in place for the next few years to minimise further disruption.

He said in his report, however, that the restructuring had been expensive and had taken managers’ eyes off the priority of running the service.

Norman Lamb, the Liberal Democrat health spokesman, said: “This report is a damning critique of the Government’s failure to get value for money out of all the extra investment in the NHS. Ministers cannot ignore these recommendations as they did with last year’s report by Sir Derek into social care.”

Andrew Lansley, the Shadow Health Secretary, said: “Even Gordon Brown’s own adviser thinks he has mismanaged the NHS. Labour have invested lots and achieved too little. Gordon Brown is obsessed with pursuing top-down reorganisation instead of delivering genuine reform, which gives power to professionals and better healthcare to patients.”

He added: “Public health budgets have been robbed to pay off huge deficits despite warnings about the strain that spiralling obesity levels will have on the NHS. Labour’s ignorance belies their arrogance.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article2433049.ece