Realism returns after initial excitement over the chancellor's pounds21bn

A certain sense of reality has at last begun to creep back into the debate about chancellor Gordon Brown's headline-grabbing pounds21bn, and not before time (See News, page 2; News Focus, pages 10-11; Politics, page 19). For despite the spin, it is now fairly clear that the sums made available to the NHS are adequate but hardly overwhelming in their generosity.

The small table published alongside our lead news story this week puts the chancellor's handout into its historical context: over the five years of this Parliament, Labour will have increased health spending considerably faster than the Tories did in their final, abysmal term of office, and slightly more than they did over the lifetime of the Thatcher and Major governments.

The government, of course, would rather that people concentrated on the percentage rise on offer for the final three years of its term, as if ignoring the relatively small increases of its first two years would make the problems that cumulative underfunding causes go away. The deliberate underestimates put forward by the Conservatives stand up equally badly to analysis.

But it is probably fairer to compare the extra cash put into the NHS over the three years of Labour reform with that put in by the Tories during a similar period of disruption. NHS restructuring costs money: the Tories knew that and threw money at the problem, not all of which was well spent; Labour seems taken in by its own rhetoric, and wrongly to believe its reforms will free up cash.

In fact, two sources of financial pressure will build up over the next few years, perhaps to the point where they become irresistible. The first is pay: for decades, NHS pay has slipped behind, only to jump back into line in big catch-up awards. The slogan 'Remember Halsbury' echoed through nursing long after anyone still did. 'Remember clinical grading' might well be today's equivalent.

The second is of the government's own making: in bowing before the doctors over who should run primary care groups, health minister Alan Milburn ceded control over their spending. He did so for sound political reasons, but has left a financial timebomb in the system which may go off before the next election. What an irony if Mr Milburn were to be at the Treasury when it explodes.