THE NHS in Wales must modernise to survive - and people must take more responsibility for their own health.

Those are the key messages in a hard-hitting report on the nation's health and social care services.

The Wanless Review paints a stark picture of a financially inefficient NHS struggling to cope and of, at best, haphazard links with social services. It concludes:

Wales does not get as much from its health and social care spending as it should; Expertise is spread too thinly; There are unsupportable burdens on acute hospitals; Variations in performance between NHS trusts and within primary and social care are unacceptable; There is too much reliance on care in institutional, rather than community, settings; The current position is unsustainable.

With an extra £1.8 billion to spend over five years on health, the Assembly last autumn asked Derek Wanless, (pictured) former head of NatWest, to review health and social care in Wales.

His findings confirm an impression of a service struggling with issues such as long waiting times, cancellations of large numbers of operations, and the spectacle of more than 1,000 patients across Wales - a quarter of whom are in Gwent - blocking NHS hospital beds.

The report provides much food for thought on how health and social care in Wales should be developed.

Mr Wanless believes improvement lies not only with the NHS and organisations that link with it. It also lies with the people of Wales, as individuals and as communities. We must take more responsibility for our own health.

"No amount of effort by the health and care services can be a substitute for this," he says.