Greater spending on the NHS over the past five years, by more than £43bn (€63bn; $87bn), has failed to deliver improvements in productivity that could have led to better health care for all, an independent review has concluded.

The review by Derek Wanless, which has been carried out for the independent health think tank the King's Fund, follows up his 2002 report Securing Our Future Health (BMJ 2002;324:998 doi: 10.1136/bmj.324.7344.998), which was commissioned by Gordon Brown, then Chancellor of the Exchequer.

Although the extra spending on the NHS has led to many important improvements in healthcare infrastructure, staffing levels, and care provided for some conditions, the new report says, the opportunity to deliver better public health has been missed—with the prevalence of obesity in particular now higher than the worst case scenario forecast in the 2002 report.

“The extra resources, accompanied by fundamental reform, have undoubtedly improved patient care over the past five years,” said Sir Derek, former chief executive of the NatWest Group. “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.

“Without significant improvements in NHS productivity—and much greater efforts to tackle obesity in particular—even higher levels …