Skipper

According to Tom Bower's biography of Gordon Brown, Derek Wanless was less than happy when his 2002 report on the NHS was used selectively by the then Chancellor to justify doing nothing to change to the management and financing of the NHS(p379). The fact that he did not commission, as Wanless advised, another report five years hence, suggests Bower was right. So the Kings Fund kindly stepped in to oblige and the result we see all over the papers this morning; predictably, some are scathingly critical, while others more measured.

In today's Society Guardian John Carvel interviews the ex banker and we get closer to what his report is saying. He fears that, whilst the tax based system has done quite well since the injection of £43bn since 2002, the prognosis for the future is not so good. Certainly he thinks money has been spent in a cavalier fashion in terms of pay awards which carried no productivity pay-off, and constant reorganisation has not helped at all, but he praises the reduction of waiting lists and the employment of more doctors and nurses. The key thing seems to be the changing lifestyle of our nation. Frankly, as we are getting older and older we are becoming less healthy through our shocking eating and low exercise habits.

On a 'slow uptake' trajectory in 2002 Wanless projected the NHS would cost taxpayers from £68bn in 2002 to £154bn by 2022-3: a huge increase in percentage of GDP. The slightly odd thing to me is that he still supports the tax based model. It has seemed to me for some time that the French, German and even, in some ways, the Irish systems offer better service and value for money through complementing tax funding with a degree of health insurance.

This does not mean they are like the US system which is so obscenely costly that some 50 million of its citizens are not covered by any health insurance, but it does provide the extra layer of funding which makes the French and German systems at least, superior to the NHS. And if health costs require individuals to change their lifestyles, then some financial incentives in the form of lower health costs would, surely, be no bad thing?