The National Health Service is in a serious mess. Especially when you look at the achievements of other countries, it is a disgrace that patients in Britain so frequently end up with second-best - long waiting lists, cancelled appointments, and the knowledge that a visit to the doctor means the need to set aside half a day.

The National Health Service is in a serious mess. Especially when you look at the achievements of other countries, it is a disgrace that patients in Britain so frequently end up with second-best - long waiting lists, cancelled appointments, and the knowledge that a visit to the doctor means the need to set aside half a day.

As ever, the problem with yesterday's announcements is an excess of spin. When the Government talks about the new National Plan for the NHS as the biggest shake-up of the health service since 1948, we should feel sceptical. This is not a complete shake-up. But it is something just as welcome: considerable change at the nitty-gritty level, which is what was needed.

A genuine attempt is being made to address the question that everybody has for many years been too frightened to ask: how can we make the NHS work properly, so that its reality is even a fraction as impressive as the rosy image that we nurtured for so many decades?

In some respects, yesterday's announcement reflected an old-fashioned Labour commitment to more cash. The backbenchers could cheer excitedly - and there was plenty of reason for William Hague to start huff-puffing about how his government would match Labour's commitments. But yesterday's announcement also acknowledged that money is only part of the problem.

Purely in terms of number-crunching, yesterday's announcements are impressive. There will be an extra 7,000 NHS beds. By the year 2005, nobody should have to wait for more than six months for an operation (down from 18 months at the moment). By the year 2008, nobody should have to wait for more than three months. It still seems barely credible, and 2008 is a couple of governments away. But other countries can do it: why not the UK?

Clearly, something radical was needed. Many working in the NHS themselves admit that it is a question of: if not now, when? Over the years, spending has failed to keep pace with developments in technology and with expectations. Morale has spiralled downward, and patients felt constantly abused.

Partly, the problem was one of the emperor's clothes. The excellence of the NHS was a given; we were only allowed to talk of the magnificence of the NHS, not of its failings. Even Margaret Thatcher felt it incumbent upon her to declare that the NHS is "safe in our hands". It has taken a Labour government to say what patients have known for years: it is not good enough, and needs to change. Tony Blair rightly noted yesterday that it was "amazing" that it has taken so long to organize a serious rethink. In today's consumer-led society, people expect more, and have a right to do so.

On almost every measure, we have fallen far behind our European neighbours - so far that it seems almost shaming to admit it. That must change - and may now finally be able to do so. Britain has barely half as many doctors as the European average. If that can improve only somewhat, then so much the better. 7,500 more consultants in the next four years, a rise of 30 per cent, is more than just statistical jiggery-pokery.

In many respects, the new commitments are inescapable. Thus, any patient whose operation is cancelled for non-medical reasons will from 2002 have the right to have surgery within 28 days - at a private hospital, if need be. On the one hand, there is a welcome readiness to co-operate with the private sector. On the other hand, the insistence that consultants should have to work exclusively for the NHS in the first few years of service helps to make it clear that the private piper should not be allowed to call the NHS tune.

It would be wrong to think of tearing apart the structure of the NHS. After half a century, however, major refurbishment is long overdue. It needs more than a lick of paint - structural cracks urgently need to be repaired. If these reforms can help, then this Government will have earned its place in the history books. It remains an if. But the chance is there.