The passing of a watershed is sometimes greeted with fanfares and headlines, and at other times goes almost unnoticed. Last week's Government announcement of an extra pounds 150m funding for cancer services from the National Lottery could be just such a watershed. But it may be years before we know.
Frank Dobson, the health secretary, was enthusiastic. The money, to be paid over three years, would be "the biggest ever bonus the country has given to cancer services", he said. "It will help us deliver modern and dependable cancer services for the 21st century, saving thousands of lives with better prevention, detection and treatment."
So the product of gambling, itself a known health hazard, is to be used in an act of charity to the NHS to buy scanners, x-ray machines and "vital new cancer-killing treatments". It will come from the "New Opportunities fund", a sixth good cause Labour added to the lottery's original five shortly after it came to power.
Who could complain about that? As recent figures have shown, Britain lags behind most of Europe on cancer treatments and many hospital departments are in urgent need of new equipment. Medical organisations found themselves backed into a corner. Where was the mileage, in PR terms, in protesting about extra cash for cancer?
Clearly there is a place for charity in the health arena. Hospitals have their flower days, their leagues of friends, and their fund-raising events. The fear here is that the Government has crossed a boundary by ditching the principle that lottery money should never be used to subsidise state spending.
A founding principle of the National Lottery, endorsed by Labour in opposition, was that of "additionality" - that money should go only to schemes additional to those funded by the Government. Since scanners and x-ray machines are essential to the work of cancer departments but have also been bought for hospitals by charities, the definition of what is "additional" has been conveniently muddied.
Ministers deny they are exploiting this confusion and say they are merely building on local fund-raising efforts. There is no question of state spending being eroded and they cite the pounds 21bn promised over the next three years as evidence of their good intentions.
We should treat these pledges with a healthy scepticism. The British Medical Association observed that there were advantages to using a central pot - the lottery - to build on local fund-raising efforts, because it could even out inequities across the country. But it added that it was "sad" and "disappointing" that the Government was relying on lottery money to fund what should be regarded as "mainstream core services".
The NHS Confederation, representing hospital managers, sounded a similar warning. It did not wish to look a gift horse in the mouth but it was reluctant to accept charity for core services that ought to be provided by the taxpayer.
This, however, is only the beginning. When the lottery started in 1995, there were five good causes: charities, the millennium, the arts, heritage and sport. Each received 20 per cent of the pot.
The sixth good cause, the New Opportunities Fund, added in 1997 to support government-chosen projects, currently takes 13.3 per cent of the pot rising to 20 per cent next October. From 2001, however, when lottery funding of millennium projects will end, its share will rise to one third of all good cause money - about pounds 500m a year.
That will buy rather more than a few cups of tea for volunteer workers at the local hospice and it is hard to believe that Gordon Brown or his successor at the Treasury will make his dispensations without regard to it.Reuse content