Blair's pursuit of popularity must not blind him to financial realities

Prime minister Tony Blair revealed what keeps him awake at night in his party conference speech last week. Along with routine concerns about his children and whether Newcastle United would be relegated, he has to cope with 'these big worries' - and heading the list came 'when's the health money really going to make a difference?'

Making a difference is crucial to this government. It defines 'making a difference' as having a perceived, and favourable, effect on public opinion. Risking - let alone courting - unpopularity is anathema.

So far, the NHS is proving an intractable government weak spot. No surprise, then, that Mr Blair should crown his speech with two sparkling promises: a dial-a-dentist on the NHS scheme, and extension to all of the sort of choice over hospital appointments hitherto the preserve of the private sector's paying patients.

Both would certainly have an effect on how the public judged the government's stewardship of the NHS. They would also have an equally startling effect on the NHS's resources if they were to be implemented as comprehensively as Mr Blair implied.

Eagerness to please has displaced reality here - unless chancellor Gordon Brown is to disgorge some of his surplus. If not, it will be down to managers to fulfil these promises alongside all the others.