For a former banker, Sir Derek Wanless seems to take a cavalier approach to spending other people’s money. Five years ago, the former NatWest chief executive recommended an enormous boost to the National Health Service budget which Gordon Brown duly delivered by raising taxes. Now Sir Derek says the results have been disappointing – but wants even more money spent on the NHS.

The first Wanless report into future health trends in the UK was commissioned by Mr Brown in 2001. The chancellor wanted an independent business figure to justify raising taxes to increase spending on the health service. Sir Derek duly obliged in his 2002 report, saying that to create a “world-class” health service the NHS budget would have to rise from £68m a year to between £154bn and £184bn by 2022.

His latest review examines what has been achieved in the first five years. Total UK health spending is now £113.5bn, after a real increase in the NHS budget of almost 50 per cent that broadly matches the target he set in 2002. In return for what Sir Derek calls this “investment”, there have been some improvements in performance, but it is still far from “world-class”.

One reason is that almost half the extra cash has gone into higher pay and higher prices. Big pay rises and increased staff numbers have not produced similar increases in treatments. And while patients are moderately happier about the NHS, they continue to grumble about poor cleanliness, insufficient privacy and lack of personal attention.

Nor can the NHS fall back on the defence that it is seriously underfunded in comparison with other European countries. At 9.3 per cent of gross domestic product, health spending is close to the average and above the level in some countries where the service is much better.

Mr Wanless’s solution is to continue pumping in more money, especially since obesity will add to demand. He warns that productivity must increase and says it is too soon to say whether the current reforms will be effective. But his detailed prescriptions are basically administrative attempts to make this monument to central planning work more effectively.

Most bank managers faced with such poor returns from an already enormous investment would demand a new business plan before agreeing to further cash. But Mr Wanless rejects any change as “dangerous”.

Pumping more money into this tax-financed, free-at-the-point-of-use service which lacks basic incentives to meet patients’ needs will always disappoint. It is time for a report that looks at the options for a health service founded in the austerity of the 1940s that still makes sick people wait months for treatment in one of the world’s wealthiest countries.

Rough justice

The disappearance of Madeleine McCann has produced a media feeding frenzy that is gripping the nation. One common theme in much of the reporting – particularly among the tabloid newspapers – is that the Portuguese authorities have been found wanting in failing to nail a culprit. This is rank hypocrisy, given the string of miscarriages of justice in Britain over the past 50 years.

The long list of convictions overturned in the UK includes Timothy Evans, Stephen Downing, the Guildford Four and the Maguire Seven. More recently Angela Canning and Sally Clark were wrongly convicted of murdering their babies. In many cases, miscarriages have followed enormous media interest in cases that shocked the public – putting excessive pressure on the police to secure convictions.

Certainly the local plods in Praia da Luz were slow off the mark – though much the same would be the case in many remoter parts of the UK. But what seems to have galled the British press pack is the refusal of the police to hold press conferences about every twist and turn of the investigation. The tabloids use such information to convict prematurely anyone detained for questioning, as happened in last year’s hunt for the killer of five women in Ipswich.

Not so fresh air

Has anyone else noticed that an unpleasant by-product of the smoking ban in enclosed public places is that it is now much less pleasant to sit outside pubs and restaurants?

Apart from the pall of smoke, outdoor areas are now littered with fag-ends and packets. Walls are festooned with notices about where smoking is not permitted.

Time for a ban on smoking in open public spaces!

Send your comments to john.willman@ft.com

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