The NHS still has "serious shortcomings" despite the extra billions poured in by the Government, a think-tank said today.

Most Government targets are now being met but patients still suffer in areas such as mental health and strokes, Civitas said.

Evidence has shown that some patients are kept in ambulances outside hospital until staff are sure they can be seen within the four-hour A&E target, according to the report. And on public health, obesity rates have risen by a "staggering" 500 per cent since 1980 and nearly 25 per cent of the adult population is clinically obese.

James Gubb, the author of the report, The NHS and the NHS Plan: Is The Extra Money Working?, said: "In the vast majority of areas improvements in the NHS have in no way increased in proportion to the vast sums of money ploughed into its coffers.

"Is the extra money working? To a limited extent one has to say yes, for there have been achievements; most notably the NHS's historic inability to deal with long waits for elective care is apparently being reversed.

"But is it working anything like one would hope? Definitely not. Service improvement has in too many areas resembled a country stroll, whereas expenditure has increased at a sprint."

The Department of Health said the report failed to highlight many areas of increased productivity, including delayed discharges from hospital being reduced by over 60 per cent in the last four years. Efficiency savings over-all stood at £1.7 billion - £200 million ahead of the Government's target.

A spokesman added: "Our investment has delivered new hospitals, walk-in centres and GP surgeries, more doctors and nurses and has helped the NHS achieve the lowest waiting lists on record.

"There have also been reductions in the 'big killers' like heart disease, and cancer patients are receiving the fastest-ever treatment.

"We're now driving forward with plans to deliver £6.5 billion in efficiency savings within two years.

"Reforms like doing more procedures outside of large hospitals, payment by results, and encouraging the NHS to share administrative functions, will ensure every extra penny is wisely spent."

He said it was true that an increasing number of treatments were being carried out during the day. This reduced treatment costs by about £20 million and enabled more patients to go home earlier.

Dr Jonathan Fielden, deputy chairman of the British Medical Association's consultants committee, said it was not true that the extra funds invested in the NHS had been wasted but agreed more improvements were needed.

He added: "However, much more progress could have been made without the diversion of funds into poor value-for-money schemes such as PFI (private finance initiative, ISTCs (independent sector treatment centres) and blind faith in the benefits of market-orientated healthcare.

"The chronic under-investment for years in the health service had to be reversed, taking much of the funding that could have come to frontline care.

"It is, however the pursuit of market-based healthcare that has diverted too much of the welcome extra funding down an expensive blind alley."

Shadow Health Secretary Andrew Lansley said: "This is a damning summary of the Government's financial mismanagement of our NHS.

"Increased spending has not been matched by productivity gains. On the contrary, the NHS is crippled by deficits resulting in job losses and service cuts."