It comes as no surprise that Sir Derek Wanless believes that the promise laid out in his seminal 2002 report is becoming a dream deferred.

It comes as no surprise that Sir Derek Wanless believes that the promise laid out in his seminal 2002 report is becoming a dream deferred.

As we exclusively report this week (news, page 5), he is about to begin work with the King's Fund on a five-year-on follow-up - it is likely to show that far too little progress has been made on achieving his 'fully engaged scenario' (news analysis, pages 16-17). Indeed he says that in the case of obesity, progress equates to the most pessimistic (and expensive) of his 2002 predictions, 'slow uptake'.

Speaking to HSJthis week, he was uncharacteristically open. For instance, he joined the Conservatives in calling for the health secretary - and indeed Whitehall more generally - to focus on the nation's health rather than the NHS itself, thereby implicitly supporting the concept of an independent board. This is not surprising given his general dissatisfaction with the pace of development for commissioning. He also rightly expresses concern about a heedless rush into independence, saying that in practice it 'will mean a very tightly defined framework'.

How much influence Sir Derek still wields remains to be seen - the King's Fund is having a good time of it, but this isn't a government-commissioned report. That said, it cannot do any harm that his former patron, Gordon Brown, is likely to be prime minister by the time the new report is published.

Ironically, Sir Derek says one of the reasons he wants to do this work is because one of his recommendations has been ignored - that his 2002 report would be regularly reviewed every five years. For this and many other reasons he is likely to give the government a rough ride.