The most expensive breakfast in history Revisiting the Wanless review 20 years on

20 years on from the Wanless report, we look back at its origins, methodology and impact, highlighting the learnings that can be applied to the pandemic recovery.

On Sunday 16 January 2000, in what rapidly became dubbed 'the most expensive breakfast in history', the Prime Minister Tony Blair went on the BBC’s flagship weekend political programme Breakfast with Frost. Blair declared that all things being equal, the UK would increase its health spending up to the European Union average by 2005.

2 years later, in April 2002, Securing our future health: Taking a long-term view was published. Commissioned by the Treasury and chaired by Derek Wanless, this review proved to be the first serious attempt by any government in the history of the NHS to make an independent assessment of the service’s likely future needs, and likely cost, over the next 20 years.

In this study, Nicholas Timmins looks back on the Wanless review and explores its impact in the short and long term. Drawing on insights from interviews with many of the key people involved at the time, the report highlights lessons from the original review that could be applied today. These historic issues are even more important to understand as we look towards recovery from COVID-19, and as the UK faces a backlog of unmet demand for NHS care, unreformed social care, major workforce issues, and investment sorely needed elsewhere in the public sector.

Note: in 2024 the author added two short postscripts to the account (see below). The first sheds new light on the run up to the Breakfast with Frost broadcast, while the second reflects further on the original text's somewhat downbeat assessment of the two Wanless reports’ impact on public health.