Funding will need to increase substantially to deliver the aspirations of the original review, even with improved productivity and self-management by patients of their health.

The NHS will fall short in funding by£15.2bn,£9.2bn and£7.2bn by April 2011 depending on progress defined by Sir Derek as slow uptake, solid progress or fully engaged.

The NHS is in better shape than in 2002 to deliver improvements in productivity but this will be a ‘huge challenge’.

New pay contracts accounted for£18.9bn of the extra£43.2bn given to the NHS since 2002 – but there is ‘very little robust evidence’ to demonstrate ‘significant benefits’.

The government has exceeded its targets to employ more staff – but more will be needed from as early as next year.

Delays with the national programme for IT could undermine productivity games envisaged by the 2002 review.

Poor out of hours services are partly accountable for the increase in emergency hospital admissions, the biggest rise in the acute sector at 35 per cent.

Prescriptions rose by more than a fifth between 2002 and and 2006 but cost increased by 0.3 per cent, mostly due to low-price lipid-regulating statins.

There has been ‘clear and notable improvements’ with more staff and equipment, improved infrastructure, reduced waiting times and access and improvements in coronary heart disease, cancer, stroke and mental health.

Mortality rates have fallen and life expectancy has increased – but a ‘relatively low priority’ has been given to public health, particularly an ‘unforseen’ rise in obesity. Policy has been ‘piecemeal’.

The NHS has failed to reduce ‘relatively modest’ unit cost reductions called for in 2002. Broadly, unit costs have increased for all hospital services.

Implementation of policy has been ‘slow and uncertain’ and pressure to produce quick results has led to policies being introduced without adequate preparation. The government failed to take full account of the impact of new policies on the system as a whole.

Questions remain over evidence for hospital reconfigurations.