Blair shown mountain to climb on NHS

The daunting scale of the problems facing the health service over the next 20 years - and the colossal sums needed to fix it - is being spelled out this morning in a report forming Gordon Brown's basis for the biggest investment ever seen in hospitals and doctors' surgeries.

The report, which the Chancellor commissioned from Derek Wanless, former chief executive of NatWest, is expected to pull no punches when it comes to describing the task facing Tony Blair over his promise to revolutionise the NHS.

A lack of adequate information technology of the type available in banks, high street shops and almost every other aspect of British life, was highlighted as an example of the woeful lack of basic equipment in the NHS.

But Mr Wanless has also given Labour a great gift - his strong support for the present system of funding, out of general taxation.

His report is likely to compare Britain's underfunded system with other countries, but come out in favour of the method set out by Nye Bevan in 1948. He will close the door on other forms such as social insurance or a USstyle reliance on private medical insurance as penalising the poor and elderly.

His previous interim report, published last autumn, estimated that Britain had suffered a cumulative under-spend of up to £267million during the Seventies and Eighties. But today's document is not expected to give one figure for the amount the Chancellor-should pump into the system. Instead, it will set out a number of scenarios giving varying sets of figures, based on estimates of how demand for care may rise, and how quickly thousands of extra doctors and nurses can be brought in.

Before it had even been published today, the report ran into trouble. The Tories accused Labour of deliberately withholding publication until now so that its uncomfortable message would be swamped by Budget coverage.

The report, described by someone who had seen it as "impenetrable" will not be ignored. Its contents will be pored over for weeks, because it sets out the perils facing the country over the shaky future of the NHS.

The question for Gordon Brown is whether pumping in some £25billion into the health service over the next five years can really transform the hospitals quickly enough for the public to feel the difference.

Mr Wanless does not avoid the question of quality. He is said to be particularly concerned by the absence of decent computer technology - he has been shown hospitals with systems which are still unable to send a patient's notes to their GP.

But there is even more doubt over the speed with which nurses, doctors, radiotherapists and others can be wooed back to the service in order to expand it fast enough to meet the growing

hunger for medicine. Capacity is the biggest problem for the health service.

Health experts point out that it is not just about training more doctors - any increase in the number of surgeons means more operating theatres, more beds on wards, and more care for patients discharged from hospital. Nurses have been coming back but there is still an enormous reliance on temporary agency nurses, which costs the NHS about £2billion a year.

The Wanless report also highlights other areas of rising costs - heart drugs and other new therapies, staff pay rises, which have been significantly-above inflation in the last few years, hi-tech equipment such as CT scanners, and the increasingly litigious public, as legal bills mount.

Many fear the money will disappear into a black hole. Both the Chancellor and Mr Wanless will argue, yet again today, that investment cannot be made without reform.