The sum of £20 billion is, even by the standards of Whitehall, a great deal of money. Yet it is that figure which Nick Bosanquet, Professor of Health Policy at Imperial College, London, believes will be spent on the NHS needlessly by 2010-11 unless the balance between cash and reform is altered. If more radical action had been taken in the past or were adopted in the future, then Britain could have the same high quality of health provision for 9 per cent of national income seven years hence than the 11 per cent which, on current trends, is probable.

The science of estimating costs on a scale this large and over a timetable so long is inevitably imprecise and open to questions. The professor does, however, come to this debate armed with considerable personal credibility. He is a strong supporter of the NHS who believes that it is improving and delivering notably better services in many domains, thanks in part to the extra resources poured in by ministers. He has publicly applauded many of the initiatives taken by the present Health Secretary. He cannot be fairly portrayed as a wild-eyed fanatic determined to privatise hospitals, throwing patients on to the streets in the process.

Indeed, John Reid must regard this research as helpful to his own efforts. It shows, for example, how the choice programme for heart operations introduced first in London and then nationally had such a dramatic impact on incentives that waiting times tumbled. A similar drive to introduce competition has reduced waiting times for hip replacements and cataract treatment. The suggested extension of private sector involvement in other areas of the NHS should not be beyond the pale for a Secretary of State who properly prides himself on his pragmatism. Nor should he find embarrassing the assertion that the “core” NHS needs to be more like his new treatment centres.

For there is time and scope for Mr Reid to close, if not eliminate, the gap between what funds for the NHS can achieve and what is actually being recorded. He should have every reason to do so because, as Professor Bosanquet points out, an NHS that fails to change sufficiently will face impossible demands from the costs of the Private Finance Initiative, extra staffing, the GP contract, additional treatment and diagnosis, new drugs and new technology in the future. It would be better for Mr Reid to anticipate this now than burden his successors later.

The most important aspect of this, nevertheless, is a change in mentality. Some of Mr Reid’s unreconstructed parliamentary colleagues assume that compassion is measured by the scale of public money spent on policy.

Britain has agreed a one-off boost in public spending for the likes of the health service. It is clear, nonetheless, that increasing numbers of people feel that they are paying quite enough tax. If Gordon Brown has any intention of increasing national insurance contributions as an alternative to raising taxes to fund unproductive public spending increases, he will find that respect for him erodes more quickly than cash often appears to disappear within the NHS at the moment.