COMMENT : Does his largesse only flag up the NHS's insatiable appetite for resources?

Just 12 months after the biggest spending increase in the NHS's history, chancellor Gordon Brown announced yet another£1bn extra for the service in his Budget for 2001-02. Before last year, an increase of half that amount would have guaranteed mingled pleasure and surprise from managers. Today, perversely, compared with last year's shock statement it seems almost like small beer, virtually an afterthought.

It is, of course, neither small beer nor an afterthought. Carefully deployed, it should make an appreciable difference to the service. But it carries slightly disturbing connotations too.

First is the habitual ringfencing. Ministers would stand the best chance of the money being deployed to best effect by leaving it to local managers to decide how to spend it.

Instead, hearts will sink at the prospect of having to mount a case in order to bid for a share: all that management time and effort diverted at a point when many already feel run ragged by the remorseless demands of the change agenda.

But perhaps more unsettling to the contemplative analyst is the quiet reminder Mr Brown's£1bn extra emits of the NHS's insatiable appetite for resources. Could there be some truth after all in the prophecies of doom from the Jeremiahs crying in the political wilderness that no matter how much the government commits, the NHS will never have enough money? Wouldn't it have been perceived as a sorry admission if in last year's Budget debate the chancellor had acknowledged that 12 months hence he would be adding yet another£1bn to the record projected totals unveiled in March 2000? And these questions lead inexorably to another: assuming Labour wins the general election, how long will it keep up the payments? Might it lose patience part way through a second term?

Naturally, the rhetoric suggests otherwise. With a strong exchequer and the political will, the NHS can feel confident of a fast flow of increasing resources. But in this global era, the former will depend largely on other major nations balancing the spinning plates of their economies; the US's is already wobbling, while Japan's is clattering to the floor. The latter will depend on the service itself producing tangible results which assuage health as a vulnerable issue for the government. Despite Mr Brown's largesse, tough times still lie ahead.