State of the nation With an ageing population, lifestyle epidemics and the rising cost of drug therapies, is the NHS doomed? Philip O'Hagan believes that research might have the answer There has long been a question mark over the future of the NHS. As far back as 1997, the Policy Institute King's Fund posed the question "Funding the NHS: Is the NHS sustainable?" More recently, in his 2002 report to the government, Securing our Future Health: Taking a Long-term View, Sir Derek Wanless made a number of proposals to improve the quality of service, including an increased reliance on primary care for diagnosis and treatment. These are issues that TNS Healthcare has been following for the last decade through a series of in-depth Delphi studies. TNS examined the structure and funding of healthcare systems across five key European countries -- Britain, France, Germany, Italy and Spain -- together with Japan and the United States. The latest in the series, Healthcare 2010 -- which was completed in 1999 -- drew on the predictions made by a number of experts in 1997 and looked forward ten years to consider what further changes might take place. Crisis management In a separate series of clinical Delphi studies, TNS Healthcare examined the changes predicted to occur in the diagnosis, treatment and management of disease such as diabetes and how such changes might affect healthcare funding and delivery over the succeeding 15 to 20 years. The combined results of these studies reveals a potential healthcare crisis