Sir Derek's latest review 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. Though he sees some improvements in the service, he has also pointed out a range of failings, including mismanaged structural changes; generous pay deals that failed to produce an obvious return; and a neglect of public health.
Though Sir Derek agrees that the extra resources had undoubtedly improved patient care over the past five years, he adds that: "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."
Sir Derek further 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.
Out of the more than £43 billion extra that has been spent, pay and price inflation have accounted for £18.9 billion, Sir Derek 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", he says.
In addition, 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 behavior, shorter waiting times and changes in GPs' out-of-hours arrangements, the report suggests.
The review also says that public health budgets, aimed at tackling issues such as obesity and smoking, had been raided to bridge financial problems in the NHS. According to Sir Derek, it was impossible to track trends in public health spending or health promotion in the past five years because no official figures were kept. He added: "It is also indicative of the relatively low priority given to public health that, while nonpublic 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 acknowledged "lots of positives" in his study, which 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 minimize further disruption.
However, he said that the restructuring had been expensive and had taken managers' eyes off the priority of running the service.
In response to the report's warning of soaring obesity rates, Alan Johnson, the Health Secretary, will call today for direct intervention to encourage healthier lifestyles. He is expected to tell members of the New Health Network that the future of the NHS depends on encouraging people to take care of themselves.
"Government simply cannot afford to be the passive observers of unhealthy lifestyles, only intervening when chronic diseases such as diabetes, heart disease or lung cancer are already well established," he is expected to argue. "Public health issues must be elevated to the top of the national agenda by a Department for Health which takes an even more active role in encouraging healthy lifestyles."
Meanwhile, Norman Lamb, the Liberal Democrat health spokesman was quoted: "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, added: "Even Gordon Brown's own adviser thinks he has mismanaged the NHS. Labor have invested lots and achieved too little. Gordon Brown is obsessed with pursuing top-down reorganization 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 spiraling obesity levels will have on the NHS. Labor's ignorance belies their arrogance."
Meanwhile, a spokeswoman for the Department of Health was reported: "We welcome this report and its recognition that the Government's investment and reform have improved patient care. We agree that more has to be done to improve NHS productivity and to tackle some lifestyle issues like obesity. We also agree that spending on healthcare will need to continue to grow above inflation if we are to meet patients' growing expectations.
"These issues will be central to decisions made in the next few weeks as part of the Government's Comprehensive Spending Review and the long-term review of the health service being conducted by Lord Darzi", she added.