Healthcare leaders have enthusiastically welcomed the unprecedented £40bn ($58bn; 65bn), five year investment plan for the NHS announced in the Budget last week, while also sounding notes of caution over elements of the reforms that are tied to the money.

Chancellor Gordon Brown's Budget outlined annual rises of 7.4% above inflation for the NHS over the next five years, taking total UK healthcare spending from £65.4bn in 2002-3 to £105.6bn in 2007-8. The total 61% boost, which will be paid for by a 1% rise in national insurance, is in line with increases recommended by the report on health resources by Derek Wanless (see p 998).

The extra investment will increase the UK health bill from 7.7% to 9.4% of gross domestic product by 2008—matching the EU average that Prime Minister Tony Blair pledged two years ago that the UK would meet (BMJ 2000;320:205).

The health secretary, Alan Milburn, immediately translated the money into plans for an extra 80000 staff, …