Content area
Full Text
Wanless's fully engaged scenario means a bigger role for public health
Poor levels of health in the population will put considerable pressure on the NHS that risks swamping the government's efforts to meet targets and achieve solid gains through its sizeable injection of money. Not surprising, then, that former banker Derek Wanless's report on long term funding challenges for the NHS, which was published last year, struck a chord with ministers and advisers. 1 In his 2003 budget the chancellor invited Wanless to provide an update of the long term challenges in implementing the fully engaged scenario. 2 This scenario was the most ambitious and optimistic of the three scenarios described in Wanless's first report and has been endorsed by the government. It contains heroic assumptions about the ability of people to take greater responsibility for their health, and services to transform themselves through efficient use of resources and a high rate of uptake of technology. A dramatic improvement in health status is anticipated with life expectancy going beyond current forecasts. But the real appeal of the scenario for the government lies in an estimated saving to the NHS of some £30bn ($47bn; â,¬43bn) if it succeeds.
The plea of the former health secretary Alan Milburn for a better balance between prevention and treatment in health policy seems to have gone unheeded. 3 The government remains preoccupied with downstream acute care. The call for a "sea change in attitudes" has not happened. Public health remains marginalised and lacks capacity, especially in primary care trusts, to challenge effectively...