King's Fund economists Sean Boyle and Anthony Harrison said: 'An extra £18bn in England over the next three years will bring total spending in the NHS to £46bn by March 2002.

On current assumptions about general inflation, this would be a real rate of growth of 4.7 per cent over the next three years.

The five years of Labour government would see an increase in average spending of 4 per cent compared with just 2.5 per cent under the previous Conservative government.

However, in the past NHS costs have increased more quickly than the general rate of inflation. Recent tightening of pay deals has reduced this discrepancy, but at the expense of a growing gap between public and private sector pay levels. This may be unsustainable.

The government is careful not to expose its assumptions about NHS costs, but if these were to follow previous patterns then the increase in spending power during the lifetime of a Labour government may be closer to 3 per cent.

But the public has ever-increasing expectations, and 'enough' is never enough.'