Press Releases

HISTORIC PRESS RELEASE : Review of Long-Term Health Trends by Derek Wanless [April 2002]

The press release issued by HM Treasury on 17 April 2002.

Derek Wanless today published his Final Report – ‘Securing Our Future Health: Taking A Long-Term View’.  This is the first ever evidence-based assessment of the long-term resource requirements for the health service in the UK.

The Report builds on the Review’s Interim Report published on 27 November 2001, which set out the main trends affecting health care over the next 20 years and was followed by a period of consultation in both the UK and around the world.

Announcing publication of the Final Report, Mr Wanless said:

“If our health services are to meet people’s expectations and deliver the high standards over the next 20 years, we need to devote a significantly larger share of our national income to health care.  But money on its own is not enough and provides no guarantee of success – it is essential that resources are efficiently and effectively used.

Resources and reform must go hand in hand – both are vital. Neither will deliver without the other.”

The Final Report describes the Review’s vision of a high quality health service in 2022.  Patients are at its heart, demanding and receiving safe, high quality treatment, fast access and comfortable accommodation services.  This is an ambitious goal for the present health service and a huge challenge to deliver.

The Report sets out the Review’s projections of resources required over the next 20 years to deliver a high quality health service, recognising a range of possibilities for the future in three scenarios.  The projections show the UK spending between 10.6 and 12.5 per cent of GDP on health care by 2022-23, compared to 7.7 per cent today.  The average annual real terms growth rate in UK NHS spending is between 4.2 and 5.1 per cent over the 20 year period.

The projections are in five year blocks. These show the highest growth in spending in the early part of the Review period – an average of between 7.1 and 7.3 per cent a year in real terms over the first five years.  This reflects the need for significant investment to allow the NHS to ‘catch up’ to standards elsewhere and to create the capacity essential to expand choice in future.  The Report stresses that the pace of growth must be considered within the context of the service’s capacity. The Review notes that its projections are therefore at the upper end of what should be sensibly spent.

Mr Wanless said:

“I believe that it is right that there should be substantial investment quickly: there is an unacceptable gap in performance between the reality of the NHS today and what will be expected and needed in the future. But this investment must not be more than can be sensibly spent. My projections reflect this balance, but represent a very considerable management challenge.”

Growth moderates during the second decade as the NHS increasingly “catches up”, so that in one of the scenarios health spending at the end of the 20 year period is growing broadly in line with GDP.

The Report also makes a number of observations about the effective use of resources.  Mr Wanless said:

“The right incentives must be in place to ensure money is spent at the right time, in the right place and in the right way. There must be clear standards of quality, greater local flexibility in delivery and independent audit of all spending.

We must also encourage greater public engagement in the service in order to increase levels of health awareness and to establish a more effective partnership between the public and the health system.”

The Report also stresses the need for a “whole systems” approach to care – and in particular the importance of integrating thinking about investment in social care with health care.


1. Budget 2001 announced that Derek Wanless, former Group Chief Executive of NatWest Group, would undertake a review of the technological, demographic and medical trends over the next two decades that will affect the health service.

2. The terms of reference for the Review were:

(1)      To examine the technological, demographic and medical trends over the next two decades that may affect the health service in the UK as a whole.

(2)      In the light of (1), to identify the key factors which will determine the financial and other resources required to ensure that the NHS can provide a publicly funded, comprehensive, high quality service available on the basis of clinical need and not ability to pay.

(3)      To report to the Chancellor by April 2002, to allow him to consider the possible implications of this analysis for the Government’s wider fiscal and economic strategies in the medium term; and to inform decisions in the next public spending review in 2002.

The report will take account of the devolved nature of health spending in the UK and the devolved administrations will be invited to participate in the review.

3. The Interim Report on Derek Wanless’ Review was published on 27 November 2001, together with the proceedings of a Health Trends Conference held in London on 18-19 October 2001.

4. Mr Wanless’ Final Report is published today, together with an international comparative study, “Health care systems in eight countries: trends and challenges”, commissioned by the Review.

5. All four documents are available on the Review’s website.

6. The Final Report, in the light of consultation responses, confirms the main trends that will affect health care over the next 20 years, first set out in the Interim Report:

  • rising patient and public expectations;
  • delivering a ‘world-class’, high quality service;
  • changing health needs of the population (including demography);
  • technological and medical advance; and
  • use of the workforce and other productivity changes.

The Final Report considers the impact each of these will have on resource requirements.