Here's a small example of the avoidable inefficiencies in the NHS that must waste time and money on a massive scale. I am currently pregnant. I started my pregnancy in one hospital and half way through, moved house and changed hospital. When I attended my first appointment at the new one I presented them with all the official documents providing evidence of the results of the routine antenatal blood tests I had had done at the first. Apparently this wasn't good enough. I was made to repeat all the blood tests and wait for the same results so that 'they could have the data on their computer system'. It would have taken 2 minutes for someone to type the results into their database but apparently the only option was for all the tests to be repeated. How often must this occur across the country? I'm sure it's not a phenomenon restricted to maternity services.What a futile waste of time and resources.

Lucy, London, England

I feel that the whole concept was designed for different times and needs to be scrapped rather than overhauled.

As things stand, money is poured into a seriously leaky bucket. Greater accountabiity is needed - not to government but to the investors - us. People should be entitled to a statement of how much they pay into the system in a unit trust type of system.

I particuarly object to paying for an NHS Dentistry service which I cannot utilise because of the poor availability of places. I'd rather keep the money and go private. I dont understand why this isn't more of a political issue than it is.

Paul Carty, Folkestone, Kent

The NHS needs to be ripped up and destroyed.

Bishop Hill, Scotland,

The NHS can never be "efficient". People expect and demand treatment for any condition regardless of cost. The desire of politicians to be liked (and voted for) prompts them to respond and so the poor old NHS has no strategy only a set of unrelated targets. A business would have to define its business much more clearly and decide what it was not going to do as well as what it was going to do. For an NHS under political control this is impossible.

Stephen Warren, Odessa,

Less wage grabs, less management. Currently the people getting the chop are the useful ones whilst the oversubscibed managers protect their own jobs.
An example of waste: The waiting lists are 'managed' by a separate department. Not true. They input patient data at a terminal. For this they get the highest pay grade (5). They don't actually manage anything, that is done at secretarial level of the appropriate department for the patient. A monkey can be a data entry clerk and you can pay it peanuts.

David Smith, Stourbridge, UK

As a guy on the radio said yesterday - "I know where the moneys' gone - the consultant down the road from us has just bought himself a brand new Aston Martin convertible, and our GP has just bought himself a holiday home in Spain.

And all because the government thought the docs and consultants wouldn't line their own pockets. Just like MPs and Cabinet Ministers don't, I guess?

Jeremy Poynton, Fromeville, 51st State

“Government simply cannot afford to be the passive observers of unhealthy lifestyles, only intervening when chronic diseases such as diabetes, heart disease or lung cancer are already well established,” I see, so once again we have this hectoring, bullying Nanny State on our backs. As if we haven't had quite enough!

Adrian Ryan, Donegal, Ireland

The chattering classes are at it again....

Peoples expectations of the NHS are continually expanding so it will never be able to satisfy everyones expectations.

On a day to day basis our NHS delivers a fantastic service, but it is obviously not without its wrinkles.

Some practises need to change, ie consultants need to do a 5 day week amongst other things.

Neither Pru Health nor Bupa can deliver what our NHS does 365 days a year.

brian bunting, chorley. lancashire, UK

My 7 year old daughter had to go to see the doctor yesterday with a suspected allergic reaction. When arriving at the GP's surgery at 3pm (the surgery where she is registered, and has always been registered), she was turned away as she had somehow become un-registered. As registering takes 24 hours (why?), she had to go to A&E (great fun that, and lengthy fun too). At A&E the diagnosis was quickly made - a burned mouth. Surely this can be better managed.

Nick Davies, Didsbury, Manchester UK

Public Health initiatives are useless without the correct legislation/action. That this is so is clearly indicated in its history, from the pump at Snow Hill to the Victorian sewage systems. We can see the same thing happening with smoking, with the latest report from Scotland demonstrating a drop in death from smoking related ilness since the smoking ban in public places. Exhortation has never, and will never prove to be an effective tool in the armamentarium of Public Health; lung disease, cardiac disease, dental decay, obesity are diseases of lifestyle, and no matter what is said, it is only on a personal level, with great effort, that any change can be made. This is not the realm of Public Health.
'Let the polluter pay', is a cry from the past with environmental issues. 'Let the disease causers pay', with swingeing taxes on tobacco, sugary foods, fatty processed foods, might well be adopted by Public Halth Departments.

W A Quirke, Derby,

We need to take a step back when reading this report then take a step forward. I will give you an example.look at the new SHA Teams set up over a year ago,who's been appointed to lead these new organisations?Various NHS Trusts Chief Excs!!!!!! look at the performance of these Chief Excs in their previous roles ?you will see clearly the extent of the problem in trying to improve the NHS. Accountability is non existant. Some of these Trusts have been placed into Special Measures yet their Chief Excs have never been held to account!!!!!! In fact ,they are now part of the teams who are expected to improve performance and push through the Agenda for Change.Any organisation placed in special measures should expect at the very least ,that the Head of that organisation is held to account?Sir Derek and Lord Darzi need to look a bit closer to home to find the answers to the failings in the NHS

Mary Hoult, Leeds , Yorkshire

Sir Derek Wanless sounds as a massenger of doom & gloom for eminent death of the NHS.It is a conspiracy to undermine the NHS as a provider of the services to benefit the private companies to take over provider role. It is successive governments' insistence on allowing a bullying free market to reign that is leading to a major health crisis. The government's untested reforms; contradictory policies and fondness for the private sector are leading the NHS ever deeper into debt.It would be wrong, therefore, to say that this new pay system has added to the financial difficulties faced by trusts. Sir Derek Wanless has been disingenuous about why, after so much investment, the NHS is now in financial difficulty. This truth is so extraordinary it is hardly believable. More than £10bn is going into private healthcare companies that don't come under the tariff system and are guaranteed the contract price, regardless of how many operations they actually carry out.

Kailash Chand, Manchester, uk

Is it not always the answer of Labour Government's to throw vast amounts of public money at problems to receive no return? It is true of the NHS, law and order and education. The sooner this squanderous inept Government is routed, the better!

Rod Ballard, Leicester, Leicestershire

This surely demonstrates what we already know - Government cannot efficiently or effectively compete with the private sector when it comes to delivering a service, whether this is education or health. The sooner we are given the chance to opt out the better, I would much rather put my tax contribution toward PruHealth or BUPA.

Doug Bates, St. Albans,

Will there ever be an efficient NHS? Surely the size of the institution ensures that we will never be able to describe it as efficient.

Judy , Liverpool, england

it may be worth examining how much of the amounts invested were for out of court settlements resulted from negligence claims. Whether the money could have been better spent on staff training and development to minimise potential negligence from occuring. Pouring money into an organisation without a radical plan to change the culture of behaviours is no different than throwing money into the ocean...for which in my view is what has happened to the huge investment funded through the increase of 1% national insurance tax.

dschoy, london,

As long as consultant surgeons are salaried employees, with salaries having no relationship to amount of work done, efficiency will be alien to the surgical departments of the NHS.
In those hospitals, where remuneration of the surgeons is related to the quantity of work they do, efficiency is generally better.

Ian Robertson, Manchester, England