Many people will welcome Sir Stewart Sutherland's decision to voice his concern at the government's failure to respond to his proposals on long-term care (see news, page 6).

The best part of a year has now passed since the royal commission published its report, and there is still little sign that ministers intend to do anything very fast.

There have, it is true, been a series of kite-flying stories in the mid-market tabloids - most of which appeared to be testing possible public reactions in advance of any firm decisions - but none of these has tackled the fundamental issues. The NHS, social services, large swathes of the voluntary sector and, of course, millions of older people and their relatives want to know who is going to foot the bills. And in a sense, certainty of any sort would be preferable to the current shilly-shallying at the Department of Health as it would at least allow individuals and organisations to plan.

No doubt the government's failure to come to a conclusion has in reality had very little to do with a desire on the part of civil servants to re-run the royal commission's debates and far more to do with the possible cost to the exchequer. But if chancellor Gordon Brown cannot be convinced that this is a worthy cause in which to invest some of his cash surplus, then what will prise open the public purse?

Health secretary Alan Milburn misjudged his response to last week's Healthcare Financial Management Association report on the rising financial problems facing health authorities and trusts (see news focus, pages 11-13). It is true that in the broad scheme of things£200m is not a massive sum. But his claim that it is still too early to predict the year-end position, and that in any event a£200m shortfall is less than the£500m deficit Labour inherited in 1997 is at best facile and at worst dangerous. The health secretary is a clever man with a reputation for getting things done, but this is not the way to do well in the next comprehensive spending review.

Mr Milburn's role as health secretary is not solely to impress Tony Blair and Gordon Brown with his promises of stringent financial control - that way lies disaster, for they will take him at his word and then expect more. As Frank Dobson clearly recognised, a large part of the job involves arguing the NHS's case in government - and Mr Milburn should use all the ammunition available to him to do that. Sir Stewart Sutherland's decision to speak out, and what must be a burgeoning post-bag on the issue of long-term care, could give the health secretary the leverage he needs to move the Treasury.

In abandoning the Treasury mindset, Mr Milburn may face accusations that he has gone native at the DoH. But better to go native as a staunch advocate of the NHS than as a Treasury calculating machine.