The review of National Health Service (NHS) funding and performance since 2002 published this week, which has been led by Derek Wanless, has something for everyone.1 2 The government's supporters will focus on progress made in appointing extra staff, modernising buildings, buying new equipment, cutting waiting lists and waiting times, and improving priority areas of service provision such as cancer and cardiac care.

The government's critics will emphasise the failure to improve productivity and the high cost of the new contracts for general practitioners, consultants, and other staff. Independent observers will note that progress on reform of the NHS and on the wider public health agenda falls well short of the most optimistic “fully engaged” scenario set out in the original Wanless reports.3 4 The implication of this shortfall is that government may need to increase planned spending on the NHS to enable it to meet future demands.

While the review provides a comprehensive and even handed assessment of NHS reform, two factors need to be borne in mind in drawing conclusions. The first concerns the …