Abstract
The Wanless report on NHS funding (Wanless, 2002) rejected alternative funding arrangements for health services in favour of general taxation. However, it outlined a gloomy picture of unfulfillable demand for health care generated by increasing public expectations, minimum standards set out in the national service frameworks and an increasingly ageing population. Capacity problems of the NHS are well known by all those who work in it and include poor information technology and workforce issues. Even if recruitment targets are met, much depends on GPs offloading some of their responsibilities to nurses, and nurses likewise cascading some of their work to health care assistants with no detriment to care delivery targets. This is all the more challenging with the current emphasis on evidence-based care, which requires a highly skilled workforce constantly updated as the research becomes available to change practice.
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