Leading article: Lavish spending has not cured NHS's ills

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The Independent Online

But the other part of the story is whether the country got good value for all the money that has been poured into our monolithic health service. A puzzled public is beginning to realise that many of the billions they thought were flowing directly into patient care have flowed into management and salary increases. The BMA ran rings round ministers when working out a new points-related pay system for GPs. The new deal, awarding lavish top-ups to doctors for doing the kind of basic tasks that most doctors did already, while giving them an easier life, was a real blunder.

In theory, Ms Hewitt can adjust the points system so as to make it harder for GPs to reach the set "targets" and claim the bonuses. But, even if she massages GPs' pay downwards, that does not affect consultants. Ms Hewitt has no mechanism in her system to cut back their eye-catching basic pay rises.

The Health Secretary would probably be sweating less if it were only a case of riding out a few weeks of unpleasant headlines. But her trials are only beginning, as profligacy at one end of the NHS has a direct impact at the other in the form of job cuts and closures. Now the brouhaha is over nurses, but just wait until the cuts start to bite deeper and it is not only nurses who have to go, but whole hospitals.

It is arguable that Tony Blair's NHS reforms were never going to solve the inherent crisis of an organisation that is far too vast and centralised to cope with the needs of a new era. They are, however, heading in the right direction, offering the prospect of postponing meltdown by providing more money overall and, in return, demanding greater financial accountability from the trusts.

What would have made the Government's line of "no gain without pain" more palatable would have been a widely agreed understanding that both the new money and the cuts were to be shared equally. Instead, the credibility of the hesitant NHS reforms has been undermined by their uneven impact. Ultimately, the health fiasco raises questions over this government's readiness to pour money into unreformed public services. The harsh truth is that billions of pounds of taxpayers' money have been wasted. Whoever gets the blame, this is something that is going to haunt Mr Blair and his ministers as the full impact of the future cuts in the NHS hits home.