It is almost a year since the NHS celebrated its 50th birthday. The great and good gathered to applaud the past and wring their hands over the future. 'Where next?' they asked. 'More of the same,' was their only answer.

The truth is the NHS is clapped out. Changing the management model and sticking the word 'new' in front of NHS is like putting go-faster stripes on a Morris Minor: neither will make the service run faster nor the money go further.

To survive the next 50 years the NHS must pass two millennium tests, the twin pillars of modern government: sustainability and consequentiality. What happens if we apply the test of sustainability to the NHS? Will the NHS melt if we can't find enough cash to cool it down? Almost certainly, yes.

How sustainable is it to pour money into fix-you-up solutions when a small investment to prevent problems in the first place might save money? For instance, genetic screening and testing can prevent all manner of illness and suffering. A triumphant health secretary recently announced another£20m for treating colorectal cancers. The same investment in genetic screening for the diseases, and the price of a daily aspirin and starch- reduced drink for those at risk, could wipe out the disease for a whole generation.

Consequentiality is a theme that runs through Home Office policy, education, employment and transport. What happens if we apply it to health? If you lead your life on the couch, watching telly and enjoying a diet of deep- pan pizzas and a six-pack, the consequences could be cholesterol, weight gain, high blood pressure and perhaps diabetes. So don't waddle in our direction, take your self-inflicted wounds elsewhere.

Sustainability and consequentiality pose no difficulties in the more courageous corners of Whitehall. Only the prisoners of self-manufactured moral dilemmas in the NHS continue with demand-induced policies that would be thought immoral everywhere else.

Sustainability and consequentiality are the uncompromising alternatives to the vagaries of rationing based on consultation, and which inevitably disallow the deserving while conceding everything to the selfish citizen. Sustainability says: you deserve everything you get. Consequentiality says: you get everything you deserve.

Roy Lilley