In 2000, the Labour government initiated a programme of NHS investment unequalled in any other healthcare system. Almost seven years on, the spending has improved services, but these improvements have not kept pace with the spending increases, say the authors.

So what went wrong?

The fundamental problem was that, as funding flowed into the NHS, many spending controls were relaxed as politicians and managers concentrated on targets for activity and service delivery, say the authors. The lack of control is most evident with respect to the role of the National Institute for Clinical Excellence (NICE), in pay negotiations, and in contracting arrangements.

After 2008, the growth in NHS expenditure will be reined in. So what needs to be done to prepare for the famine years ahead? Rather than yet another reorganisation, they suggest that NICE needs a wider remit, staff incentives need to be overhauled, and health outcomes data should be collected.

"What are needed are "hard" budgets and improved incentives that create behaviours that are consistent with efficiently improving the health of the nation," they say. "The feast is over. The famine will be harsh for patients, practitioners, and politicians."

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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
13-Apr-2006