Is it all beginning to unravel? With the NHS plan just six months old, the government's reforms are struggling on several fronts. And less than 12 months after the Budget's record increases in health spending, cries are being heard once more of mounting financial problems. With only three - maybe two - months to go before the general election, these developments will be deeply unwelcome to ministers. Alarms must be wailing in Downing Street.
The Budget effectively silenced the debate about NHS funding. But it could not do so indefinitely, despite the magnitude of the sums. The King's Fund (see politics, page 23) now calculates that the extra will not be sufficient to raise UK health spending to the European average. Meanwhile, the British Medical Association has warned that rationing remains inevitable, even at the new level of funding.
We reported a week ago that major gaps in the service and financial frameworks are threatening to hamper delivery of NHS plan promises. Some trusts are finding it difficult to match resources with demand; others are doubtful they will balance their budgets. Junior doctors' pay, consultants' intensity payments and extra pension costs have combined to bust the Department of Health's 4.9 per cent inflation prediction.
Was the NHS plan ever properly costed? It has never been clear how the service's extra funding related to the plan's aims. It was all rather vaguely taken for granted. But it could be these are the first tell-tale signs that the extra money is simply not enough.
Intermediate care funding is in serious disarray, with nowhere near the expected£150m reaching its target. Hard-pressed social services departments have siphoned off a portion to fund other priorities, particularly high-profile children's services. NHS finance directors report they are having to bail out social services, while bed-blocking remains an urgent, unsolved problem.
The plan's ambitions for restructuring the service have drifted into choppy waters too. Local authorities are getting cold feet about care trusts, wary of the governance arrangements. In practice it is probable that care trusts would be formed from the NHS taking over failing social services - rarely, if ever, vice-versa. Unsurprisingly, local authorities have rumbled this and are reluctant to surrender meekly into an unequal partnership.
Finally, health authorities are in the thick of evolution - facing merger on one hand, searching for a new role on the other - as primary care trusts are established, and doing it all in the dark without DoH guidance. Ministers do not want to get bogged down in restructuring, but it is their reforms which have set this in motion.
The solution to all these problems? Slow the pace and/or find more money. But is either likely?