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Far from settling the NHS's future, its extra funding has heralded open season for every think tank worth its salt to plot its own alternatives to Aneurin Bevan's legacy. At no time since the late 1980s, when Mrs Thatcher's behind-closed-doors 'review' of the service prompted a similar flurry, has the NHS been so bombarded with suggestions and predictions, not least from those who make no pretence of having its best interests at heart. Indeed now, as in 1988, the most vociferous lobby is that which wants an end to what is caricatured as monolithic, outdated, inefficient, unresponsive, even Stalinist.

This vision of what might lie beyond the last-chance saloon is simultaneously familiar and depressing. At its heart invariably and inevitably lies a massive expansion of the private sector, either for funding - through compulsory health insurance - or provision, or both. The NHS would wither to a safety net for those who could afford no better, or in order to provide the services the cherry-picking private sector would prefer not to touch. In some versions, the public would be given vouchers to 'spend' at the healthcare institution of their choice. Always, the blueprint is accompanied by assertions that no amount of tax funding will ever suffice, and usually by the expressed conviction that other European countries have far superior systems.

Frequently, the sources of these grand plans have not previously been renowned for their interest in health policy. They skate over the severe disadvantages their proposals would bestow - if they are even aware of them. The social injustice which most would involve, let alone the high cost and innate inefficiency, would make any politician with a modicum of nous deeply wary. The public, once made aware of the reality of these schemes, would react with a ferocity not seen since the poll tax.

Surely no risk of a Labour government taking any notice of these wild ideas? Not yet. But if the NHS fails to use its new cash wisely, Labour in a second or third term, with re-election looking less likely, might lose patience even with its most cherished creation. The landscape beyond the last chance saloon would then look very bleak.