comment Cheap jibes at 'bureaucrats' won't win the improvements everyone seeks

So far, so good - so good, in fact, that it almost seems too good to be true. But after a week of intense Budget analysis the NHS still has£4.9bn more to spend in the financial year that begins next week than it had in the one about to end, a 7.4 per cent increase above inflation.

And despite much prodding and probing, the money is indubitably real - including the surprise£2bn unveiled by chancellor Gordon Brown in his speech - and not mere statistical sleight-ofhand in the manner of the infamous£21bn announced in 1998 (though, stupidly, Mr Brown's 10,000 extra nurses turned out to be just that). What's more, barring economic catastrophe, the service will have 5.6 per cent extra for three years after that, a sounder financial foundation on which to plan development than it has had in its 52-year history.

It's disconcerting, but the good news doesn't end there. Managers have chafed at the government's propensity to earmark every extra dollop of cash and demand that health authorities and trusts bid for it. But the first£600m, to be released immediately, is to be distributed according to weighted capitation, for the NHS to decide locally how best it should be spent. Is it mere coincidence that before the Budget this is the exact sum the NHS Confederation said the service needed 'to keep the show on the road'?

Then came the complaints that the government's compulsion to centralise was by-passing managers and other health professionals who could and should be feeding their frontline experiences into policy formation. Avenues for this to happen are now to be created on a scale hitherto unseen.

Eerily, the familiar, shabby NHS landscape has been transformed. The old, much cited obstacles - and excuses for failure - to change are being swept away.

How quaint to recall that campaign of the 1980s for 2 per cent extra a year now that the NHS will average 6.1 per cent increases for the next four years. Managers, doctors and nurses united then in telling the politicians that in return they could have the service to which an ever more demanding public aspired. Now their bluff has been called.

In the words of prime minister Tony Blair: 'We rose to your challenge. Now rise to ours. Work with us to make sure the money is well spent.'

If any emotion has matched the extent of astonishment at the government's spending plans in the last 10 days it is ministers' evident anxiety to get bangs for their bucks. However free they may be with the first£600m, it would be naive to suppose that the rest will not be tightly controlled. The larger the carrot, the larger the stick. In Mr Blair's phrase, 'a step change in resources must mean a step change in reform'.

So far the stick looks like a familiar one, though it has been buffed up and is being waved a little more vigorously: managers already know all about the Commission for Health Improvement and league tables, and the threatening talk of hit squads to 'help' ailing management teams surfaces at regular intervals.

This is little more than spin doctors in search of a sexy headline - but ministers should resist the easy crowd-pleasing lines. Implying that dozy 'bureaucrats' are somehow at the root of the NHS's problems is cheap and dishonourable, and risks alienating managers just when they need to be convinced they are not only on board but up on the bridge.

Is there a hint of desperation in all this? Does the elaborate consultation imply ministers are at a loss about how to get better results out of the NHS? Does it amount to a relaunch of the reforms, and therefore, as the Conservatives allege, an admission that they have failed?

The government always said it would take 10 years to modernise the NHS. With one eye on the next election and the other on public disquiet about the service, it now wants faster results. But real change will take time. And if it takes longer than ministers would like, they must not start a hunt for scapegoats.