The first two Wanless reports in 2001 and 2002, prompting Labour's commitment to a record eight fat years of NHS investment, came with a warning. No matter how much extra resources were invested - and Wanless was in no doubt about the extra funds needed - the healthiest result required the public to be "fully engaged". The truth of this warning has been strongly underlined by news reports in the last two days. The NHS is already receiving more than double the amount that it received in 1997 and will be spending three times as much in cash terms (£90bn) by 2008. Yet still many of its managers believe the record increases need to go beyond 2008. Ministers will rightly resist.
But the demands on the service mount up. Yesterday the powerful Commons public accounts committee, which called for mandatory monitoring of all hospital-acquired infections four years ago, condemned the NHS for still not having implemented it. Some 80% of hospital infections remain unmonitored. The health secretary expanded on her plans for primary-care reforms, which would include GP surgeries for teenagers and greater autonomy over diagnostic scans, that will be included in a "health outside hospitals" white paper in the autumn. Meanwhile the new market between health units, which starts next April, looks likely to create even more instability than ministers planned, following release of the latest financial figures. Audited figures for 2003-04 show the number of NHS units in deficit rose to 18%, while unaudited figures for the year just ended show the NHS in aggregate deficit. As the auditors noted, the NHS is being launched into an exercise for which it was not designed. It is not too late to confine the new market to elective care.
Most important of all were yesterday's devastating obesity figures. There are now 1 million obese children under 16 living in the UK, one-third of Europe's total. The doctors who produced the study reported they were treating children for diseases and disorders that once were found only in the middle-aged and elderly. Which brings us back to Wanless. We know what is wrong. The biggest modern-day threats to health - tobacco, drink, and food containing too much sugar, salt and fat - all have powerful corporate bodies behind them that only the government can tackle. But there must be "public engagement" too. The "teenage health time bomb" is a good place to start pushing better diet, more exercise, less unsafe sex. Who could object? These children will face a shorter life expectancy than their parents.
