Comment : Will yet more money make a difference - and make it in time?

From next April, NHS spending in the UK will rise by£1bn more than planned, increasing by£6bn in total over this year's allocation, chancellor Gordon Brown revealed in his pre-Budget report as HSJ went to press. Clearly, the government has decided to go for broke. Quite apart from any other considerations, it is too publicly and politically committed to funding healthcare through taxation, and making it free at the point of use, to turn back now. But in keeping the faith, is it throwing good money after bad? With the economy under greater pressure than at any time in the past five years, growth forecasts cut and the already massive boost to health spending having secured little visible improvement, ministers must be asking themselves the question: what if it still makes no appreciable difference? What then?

Both question and answer were unthinkable when Labour came to power, but as party chair Charles Clarke admitted this week, parts of the NHS have 'gone backwards' since then - a startling admission from a Cabinet minister. Ought we to take it as a coded signal that health secretary Alan Milburn's days at the Department of Health may be numbered? Or was it merely an initial step in a campaign to soften public opinion to accept higher taxes to fund better health services?

There is no inkling that the government is contemplating radical alternative funding methods. The official line remains - as stated in the NHS plan - that these are inequitable and would end up costing more without any guarantee of correspondingly better services. That view is being mirrored in the Treasury's continuing investigation into the long-term future of the NHS, conducted by ex-NatWest chief executive Derek Wanless. His interim report this week suggests that technological innovation and the public's rising expectations will exert significant pressure, though the ageing population will be less of a factor than expected. But he concludes that a health service publicly funded through taxation 'remains both the fairest and most efficient system for this country'.

Only the Conservatives have so far abandoned the taxation-funding principle.

Shadow health secretary Dr Liam Fox breathlessly praises the French and German systems, while former health secretary Stephen Dorrell calls for the introduction of charges. They make no attempt to acknowledge, let alone address, the deep problems European systems face or the legitimate objections to charging. They are gambling that, come the next general election, the public will have so lost confidence in the promise of Labour's reforms they will be ready to turn their backs on the last remaining political constant of the past 50 years and vote to dismantle the NHS.

Ministers must know in their heart of hearts that, remote as it may still seem, that is a far greater possibility than in 1997. People satisfied with the NHS are now in a minority of 42 per cent, according to the British Social Attitudes survey. Will the chancellor's billions work their magic in time?