Wanless Review

NSFs, and their equivalents in the Devolved Administrations, are rolled out in a similar way to the diseases already covered (2.33).

The scope for greater future cooperation between the NHS and the private sector in the delivery of services should be explored, building on the concordat set out in the NHS Plan (6.36).

There should be a mechanism in place to ensure regular and rigorous independent audit of all health care spending and arrangements to ensure it is given maximum publicity (6.37).

The Government should examine the merits of employing financial incentives such as those used in Sweden to help reduce the problems of bed blocking (6.45).

The present structure of exemptions for prescription charges is not logical, nor rooted in the principles of the NHS. If related issues are being considered in future, it is recommended that the opportunity should be taken to think through the rationale for the exemption policy (6.75).

There is an argument for extending out-of-pocket payments for non-clinical services and recommends that they should be kept under review (6.76).

A more effective partnership between health professionals and the public should be facilitated, for example, by: the setting of standards for the service to help give people a clearer understanding of what the health service will, and will not, provide for them; development of improved health information to help people engage with their care in an informed way; in parallel with improved information, the use of pro-active policies driven by evidence of cost-effectiveness, to encourage reductions in key health risk factors; reinforcing patient involvement in NHS accountability arrangements, through measures such as Patients' Forums, the English National Commission on Patient and Public Involvement and better patient representation on Trust Boards, including the new Primary Care Trusts; and finding effective ways to provide the public with a better understanding of how their local health services are performing (6.82).

The Boards of Strategic Health Authorities (StHAs) should include local patient and business representatives (6.83).

As part of improved public engagement, the Department of Health (with StHA involvement) and the Devolved Administrations consider how a greater public appreciation of the cost of common treatments and appointments could best be achieved (6.86).

As an early step down this road towards better engagement of patients in thinking about the health service, there may be an argument for charging for missed appointments (6.89).

A further review should be conducted in, say, five years' time to re-assess the future resource requirements for both health and social care. It should be able to draw upon the better information, research findings and international knowledge base which the recommendations in Annex A are intended to deliver; and have the benefit of accumulated knowledge from the bodies charged with auditing the success of the service and its change programme (7.6).

The NHS workforce planning bodies should examine the implications of this Review's findings for their projections over the next 20 years (3.82).

Future reviews of this type should fully integrate modelling and analysis of health and social care. Indeed, it is for consideration whether a more immediate study is needed of the trends affecting social care (5.60).

The National Institute for Clinical Excellence (NICE), in conjunction with similar bodies in the Devolved Administrations, also has a major role to play in examining older technologies and practices which may no longer be appropriate or cost effective (6.11).

It will also be important to ensure that recommendations from NICE – particularly its clinical guidelines - are properly integrated with the development of NSFs (6.13).

NSFs should in future include estimates of the resources – in terms of the staff, equipment and other technologies and subsequent cash needs – necessary for their delivery (6.14).

Stringent standards should be set from the centre to ensure that systems across the UK are fully compatible with each other (6.21).

To ensure that resources intended for ICT spending are not diverted to other uses and are used productively, the Review recommends that budgets should be ring-fenced and achievements audited (6.21).

The results of this and any similar research about comprehensive measurement of performance should be examined (6.29).